目的:大约40%的结直肠癌患者会发生肝转移。肝动脉灌注化疗(HAIC)是一种有价值的治疗选择,有疗效,姑息治疗,或佐剂意图。我们研究的目的是描述技术考虑因素,安全,和接受HAIC的患者的肿瘤学结果。
方法:本回顾性分析包括2004年至2021年在我们机构接受经皮肝动脉端口放置的所有患者。人口统计,收集解剖学和技术数据。使用RECIST1.1评估肿瘤反应。Kaplan-Meier估计用于总生存期(OS)和肝无进展生存期(PFS)。不良事件(AE)使用Clavien-Dindo分类进行分级。
结果:总共360名患者(中位年龄,包括58.6年[四分位数范围(IQR):49.5-65.4];208名男性[57.8%])。在87.9%的病例中,经皮肝动脉端口置入成功,导致379个端口放置(431次尝试)。总的来说,提供了394个HAIC课程,主要是奥沙利铂(94.7%),每个疗程的中位数为6个周期(IQR:3-8)。在42.0%的端口(IIIb-V级:1.1%)中观察到AE(所有等级)。大多数港口功能障碍都可以解决,导致HAIC恢复率达到73.1%,不影响操作系统。中位OS为22个月(IQR:18-24),中位肝PFS为11个月(IQR:9.5-13)。肿瘤降级允许35.6%的患者进行手术,中位OS明显长于非手术患者(39个月[IQR:33-79]与14个月[IQR:12-16],p<0.001)。
结论:这项回顾性队列研究证明了其可行性,安全,以及经皮肝动脉端口放置对选定患者生存率的影响。
结论:经皮肝动脉端口放置是可行的,安全有效,对选定患者的生存有影响。
结论:肝动脉灌注化疗提供了有希望的肿瘤反应和总生存期,特别是在切除/消融的情况下。肝动脉灌注化疗端口使用总并发症发生率高,但严重的并发症很少见.端口修正通常是必要的,但可以恢复肝动脉灌注化疗,而不会影响总体生存率。
OBJECTIVE: Approximately 40% of patients with colorectal cancer will develop liver metastases. Hepatic arterial infusion chemotherapy (HAIC) represents a valuable treatment option, with curative, palliative, or adjuvant intent. The aim of our study was to describe technical considerations, safety, and oncological outcomes of patients receiving HAIC.
METHODS: All patients who underwent percutaneous hepatic arterial port placement in our institution between 2004 and 2021 were included in this retrospective analysis. Demographic, anatomical and technical data were collected. Tumor response was assessed using RECIST 1.1. Kaplan-Meier estimates were used for overall survival (OS) and hepatic progression-free survival (PFS). Adverse events (AEs) were graded using the Clavien-Dindo classification.
RESULTS: A total of 360 patients (median age, 58.6 years [interquartile range (IQR): 49.5-65.4]; 208 men [57.8%]) were included. Percutaneous hepatic arterial port placement was successful in 87.9% of cases, resulting in 379 port placements (431 attempts). Overall, 394 HAIC courses were delivered, mostly oxaliplatin-based (94.7%), with a median of 6 cycles per course (IQR: 3-8). AEs (all grades) were observed in 42.0% of ports (grade IIIb-V: 1.1%). Most port dysfunctions could be resolved, resulting in a 73.1% rate of HAIC resumption, without impact on OS. Median OS was 22 months (IQR: 18-24), and median hepatic PFS was 11 months (IQR: 9.5-13). Tumor downstaging allowed surgery in 35.6% of patients, with significantly longer median OS than non-operated patients (39 months [IQR: 33-79] versus 14 months [IQR: 12-16], p < 0.001).
CONCLUSIONS: This retrospective cohort study demonstrates the feasibility, safety, and efficacy of percutaneous hepatic arterial port placement with an impact on survival for selected patients.
CONCLUSIONS: Percutaneous hepatic arterial port placement is feasible, safe and effective with an impact on the survival of selected patients.
CONCLUSIONS: Hepatic arterial infusion chemotherapy provides promising tumor response and overall survival, especially in cases of resection/ablation. Total complication rate of hepatic arterial infusion chemotherapy port use is high, but serious complications are rare. Port revision is often necessary but allows the resumption of hepatic arterial infusion chemotherapy without affecting overall survival.