肝动脉栓塞术治疗囊性神经内分泌肿瘤肝转移的疗效及安全性分析

doi:10.19401/j.cnki.1007-3639.2022.09.006

中国癌症杂志 ›› 2022, Vol. 32 ›› Issue (9): 794-799.doi: 10.19401/j.cnki.1007-3639.2022.09.006

肝动脉栓塞术治疗囊性神经内分泌肿瘤肝转移的疗效及安全性分析

禹航¹(), 刘文生², 张宁³, 刘海宽¹, 陈洛海³, 姚望¹, 范文哲¹, 李家平¹, 陈洁⁴, 王于¹()

1.中山大学附属第一医院肿瘤介入科,广东广州 510000
2.复旦大学附属肿瘤医院胰腺外科,复旦大学上海医学院肿瘤学系,复旦大学胰腺肿瘤研究所,上海市胰腺肿瘤研究所,上海 200032
3.中山大学附属第一医院消化内科,广东广州 510080
4.复旦大学附属肿瘤医院神经内分泌肿瘤中心,头颈及神经内分泌肿瘤内科,复旦大学上海医学院肿瘤学系,上海 200032

收稿日期:2022-08-01 修回日期:2022-09-07 出版日期:2022-09-30 发布日期:2022-10-24
通信作者: 王于
作者简介:禹航（ORCID: 0000-0002-4903-352X）,硕士在读。
王于,医学博士,主任医师,硕士研究生导师,中山大学附属第一医院肿瘤介入科副主任。广东省抗癌协会肿瘤微创介入专业委员会青年委员会副主任委员,广东省抗癌协会胆道肿瘤专业委员会青年委员会副主任委员,中华医学会消化病学分会胃肠激素与神经内分泌肿瘤学组委员,中国医师协会胰腺病学专业委员会胰腺神经内分泌肿瘤专业委员会委员,中国抗癌协会胰腺癌专业委员会神经内分泌肿瘤学组委员,广东省临床医学学会肿瘤介入学专业委员会常务委员兼秘书。主持多项国家自然科学基金及省部级基金课题。在Oncogene、Neuroendocrinology、Cancer Medicine、Cardiovascular and Interventional Radiology、BMC Cancer等SCI收录期刊上发表论著数十篇。
基金资助:
国家自然科学基金“罕见肿瘤研究专项”项目(82141104)

The efficacy and safety analysis of transarterial embolization in the treatment of cystic neuroendocrine neoplasm liver metastasis

YU Hang¹(), LIU Wensheng², ZHANG Ning³, LIU Haikuan¹, CHEN Luohai³, YAO Wang¹, FAN Wenzhe¹, LI Jiaping¹, CHEN Jie⁴, WANG Yu¹()

1. Department of Interventional Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
2. Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Pancreatic Cancer Institute, Fudan University, Shanghai Pancreatic Cancer Institute, Shanghai 200032, China
3. Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
4. Center for Neuroendocrine Tumors, Department of Head, Neck and Neuroendocrine Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China

Received:2022-08-01 Revised:2022-09-07 Published:2022-09-30 Online:2022-10-24
Contact: WANG Yu

摘要/Abstract

摘要：

背景与目的： 神经内分泌肿瘤（neuroendocrine neoplasm,NEN）常发生肝转移,但囊性NEN肝转移（cystic NEN liver metastasis,cNENLM）十分罕见,肝动脉栓塞术（transarterial embolization,TAE）治疗cNENLM的效果尚未见报道。本研究旨在分析cNENLM经TAE治疗后的疗效及安全性。方法： 2016年1月—2022年7月在中山大学附属第一医院及复旦大学附属肿瘤医院经TAE治疗的440例NENLM患者中共有囊性肝转移患者10例,按照实体瘤疗效评价标准（Response Evaluation Criteria in Solid Tumors,RECIST）1.1来评价疗效,分别计算其术后客观缓解率（objective response rate,ORR）、疾病控制率（disease control rate,DCR）及无进展生存期（progression-free survival,PFS）。术后不良反应分级采用常见不良事件评价标准（common terminology criteria for adverse events,CTCAE）v5.0。结果： 按照RECIST 1.1来评价,ORR达到80.0%,DCR达到100.0%。10例患者中3例达到PFS,最长为25.0个月,其余患者尚未进展。不良反应主要为发热、肝区疼痛及肝功能一过性损伤等,对症处理后均可缓解,无严重术后并发症。结论： cNENLM十分罕见,TAE疗效佳,术后并发症可控。

关键词: 肝动脉栓塞术, 神经内分泌肿瘤, 肝转移, 囊性, 疗效, 安全性

Abstract:

Background and Purpose: Liver metastases are common in neuroendocrine neoplasm (NEN). Cystic NEN liver metastases (cNENLM) are rare, and the efficacy of transarterial embolization (TAE) has not been reported. This study summarized and analyzed the efficacy and safety of TAE for cNENLM. Methods: From January 2016 to April 2022, 10 patients with cNENLM were enrolled in this study among 440 patients under TAE treatment at The First Affiliated Hospital, Sun Yat-sen University and Fudan University Shanghai Cancer center. The efficacy was evaluated according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. Objective response rate (ORR), disease control rate (DCR) and progression-free survival (PFS) were analyzed as well. The common terminology criteria for adverse events (CTCAE) v5.0 was applied to evaluate the adverse effects. Results: With 80.0% ORR and 100.0% DCR according to RECIST 1.1, 3 cases achieved PFS. Among them, the longest one was 25.0 months. Disease progression was not observed in the remaining patients. The common complications were fever, hepatalgia and transient liver dysfunction, which could be alleviated by symptomatic treatment. No severe complication occurred. Conclusion: cNENLM are infrequent. TAE had significant curative effect on cNENLM, and complications were manageable.

Key words: Transaterial embolization, Neuroendocrine neoplasm, Liver metastasis, Cystic, Efficacy, Safety

中图分类号:

R735.7

禹航, 刘文生, 张宁, 刘海宽, 陈洛海, 姚望, 范文哲, 李家平, 陈洁, 王于. 肝动脉栓塞术治疗囊性神经内分泌肿瘤肝转移的疗效及安全性分析[J]. 中国癌症杂志, 2022, 32(9): 794-799.

YU Hang, LIU Wensheng, ZHANG Ning, LIU Haikuan, CHEN Luohai, YAO Wang, FAN Wenzhe, LI Jiaping, CHEN Jie, WANG Yu. The efficacy and safety analysis of transarterial embolization in the treatment of cystic neuroendocrine neoplasm liver metastasis[J]. China Oncology, 2022, 32(9): 794-799.

图/表 5

图1

表1

图2

图3

表2

参考文献 19

[1]	GOSAIN R, BALL S, RANA N, et al. Geographic and demographic features of neuroendocrine tumors in the United States of America: a population-based study[J]. Cancer, 2020, 126(4): 792-799. doi: 10.1002/cncr.32607 pmid: 31714595
[2]	DASARI A, SHEN C, HALPERIN D, et al. Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States[J]. JAMA Oncol, 2017, 3(10): 1335-1342. doi: 10.1001/jamaoncol.2017.0589 pmid: 28448665
[3]	PAVEL M, O'TOOLE D, COSTA F, et al. ENETS consensus guidelines update for the management of distant metastatic disease of intestinal, pancreatic, bronchial neuroendocrine neoplasms (NEN) and NEN of unknown primary site[J]. Neuroendocrinology, 2016, 103(2): 172-185. doi: 10.1159/000443167 pmid: 26731013
[4]	RONOT M, CUCCIOLI F, DIOGUARDI BURGIO M, et al. Neuroendocrine liver metastases: vascular patterns on triple-phase MDCT are indicative of primary tumour location[J]. Eur J Radiol, 2017, 89: 156-162. doi: S0720-048X(17)30051-7 pmid: 28267533
[5]	DEL PRETE M, DI SARNO A, MODICA R, et al. Role of contrast-enhanced ultrasound to define prognosis and predict response to biotherapy in pancreatic neuroendocrine tumors[J]. J Endocrinol Invest, 2017, 40(12): 1373-1380. doi: 10.1007/s40618-017-0723-x pmid: 28667452
[6]	刘海宽, 陈文川, 刘一铭, 等. 肝动脉栓塞术治疗42例低-中级别乏血供型神经内分泌肿瘤肝转移的近期疗效及安全性分析[J]. 中华介入放射学电子杂志, 2020, 8(2): 130-134.
	LIU H K, CHEN W C, LIU Y M, et al. Transarterial embolization in the treatment of 42 patients with low-to-intermediate grade neuroendocrine neoplasm liver metastasis with hypovascular pattern: An analysis of the short-term efficacy and safety[J]. Chin J Interv Radiol Electron Ed, 2020, 8(2): 130-134.
[7]	SHAH M H, GOLDNER W S, BENSON A B, et al. Neuroendocrine and adrenal tumors, version 2.2021, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2021, 19(7): 839-868. doi: 10.6004/jnccn.2021.0032
[8]	PAVEL M, ÖBERG K, FALCONI M, et al. Gastroenteropancreatic neuroendocrine neoplasms: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up[J]. Ann Oncol, 2020, 31(7): 844-860. doi: S0923-7534(20)36394-8 pmid: 32272208
[9]	中国抗癌协会神经内分泌肿瘤专业委员会. 中国抗癌协会神经内分泌肿瘤诊治指南(2022年版)[J]. 中国癌症杂志, 2022(6): 545-580.
	Society of Neuroendocrine Neoplasm of China Anti-Cancer Association. China Anti-Cancer Association guideline for diagnosis and treatment of neuroendocrine neoplasm (2022 edition)[J]. China Oncol, 2022(6): 545-580.
[10]	FIORI S, DEL GOBBO A, GAUDIOSO G, et al. Hepatic pseudocystic metastasis of well-differentiated ileal neuroendocrine tumor: a case report with review of the literature[J]. Diagn Pathol, 2013, 8: 148. doi: 10.1186/1746-1596-8-148 pmid: 24034980
[11]	MORIKAWA K, IGARASHI T, MISUMI S, et al. A case of pseudocystic liver metastases from an atypical lung carcinoid tumor[J]. Radiol Case Rep, 2019, 14(5): 595-601. doi: 10.1016/j.radcr.2019.02.022
[12]	李国文, 梁赵玉, 于小平, 等. 肝转移瘤血供对肝动脉化疗栓塞的近期疗效影响[J]. 介入放射学杂志, 2010, 19(6): 493-496.
	LI G W, LIANG Z Y, YU X P, et al. The influence of blood supply pattern of hepatic metastases on the short-term effect of TACE[J]. J Interv Radiol, 2010, 19(6): 493-496.
[13]	QIAN L J, ZHU J, ZHUANG Z G, et al. Spectrum of multilocular cystic hepatic lesions: CT and MR imaging findings with pathologic correlation[J]. Radiographics, 2013, 33(5): 1419-1433. doi: 10.1148/rg.335125063 pmid: 24025933
[14]	EISENHAUER E A, THERASSE P, BOGAERTS J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1)[J]. Eur J Cancer, 2009, 45(2): 228-247. doi: 10.1016/j.ejca.2008.10.026 pmid: 19097774
[15]	Department of Health and Human Services. Common terminology criteria for adverse events (CTCAE) version 5.0[R]. Bethesda: NIH, 2017.
[16]	PERICLEOUS M, CAPLIN M E, TSOCHATZIS E, et al. Hepatic artery embolization in advanced neuroendocrine tumors: efficacy and long-term outcomes[J]. Asia Pac J Clin Oncol, 2016, 12(1): 61-69. doi: 10.1111/ajco.12438
[17]	DE MESTIER L, ZAPPA M, HENTIC O, et al. Liver transarterial embolizations in metastatic neuroendocrine tumors[J]. Rev Endocr Metab Disord, 2017, 18(4): 459-471. doi: 10.1007/s11154-017-9431-2
[18]	RINKE A, MÜLLER H H, SCHADE-BRITTINGER C, et al. Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors: a report from the PROMID Study Group[J]. J Clin Oncol, 2009, 27(28): 4656-4663. doi: 10.1200/JCO.2009.22.8510 pmid: 19704057
[19]	LIU Y M, LIU H K, CHEN W C, et al. Prolonged progression-free survival achieved by octreotide LAR plus transarterial embolization in low-to-intermediate grade neuroendocrine tumor liver metastases with high hepatic tumor burden[J]. Cancer Med, 2022, 11(13): 2588-2600. doi: 10.1002/cam4.4628

Case	1	2	3	4	5	6	7	8	9	10
Age/year	56	62	57	59	39	52	57	54	52	47
Gender	Male	Male	Female	Female	Female	Male	Female	Male	Male	Female
Primary site	Rectum	Rectum	Stomach	Rectum	Pancreas	Retroperitoneum	Pancreas	Pelvic cavity	Testis	Kidney
Tumor grade	2	1	2	2	2	2	3	2	2	2
Ki-67 proliferation index/%	8	2	3	3	8	5	25	25	15	20
Extrahepatic metastasis	None	Bone, lymph node, kidney	Lymph node	Lymph node	Lymph node, peritoneum, mesentery, omentum	Bone, lymph node, lung	None	Sacrum	None	Bone
System therapy	SSA	SSA	SSA	SSA	SSA	CAPTEM	SSA	SSA	SSA	SSA
Response	PR	PR	PR	SD	PR	SD	PR	PR	PR	PR
PFS/month	12.4	NA	NA	11.7	25.0	NA	NA	NA	NA	NA
Resection	NA	NA	NA	NA	NA	NA	Pancreas	NA	Testis	Kidney
Tumor burden	10%-25%	10%-25%	25%-50%	10%-25%	>50%	>50%	10%-25%	>50%	10%-25%	>50%
Maximum diameter/mm	42.8	97.4	55.1	21.3	80.9	162.0	32.0	79.0	49.0	140.0

Item	G1	G2
Fever	3 (30.0)	0 (0.0)
Nausea and vomiting	6 (60.0)	0 (0.0)
Abdominal pain	8 (80.0)	1 (10.0)
Elevated liver enzymes	9 (90.0)	0 (0.0)

肝动脉栓塞术治疗囊性神经内分泌肿瘤肝转移的疗效及安全性分析

The efficacy and safety analysis of transarterial embolization in the treatment of cystic neuroendocrine neoplasm liver metastasis

RichHTML

PDF

可视化

摘要/Abstract

引用本文

使用本文

图/表 5

参考文献 19

相关文章 15

编辑推荐

Metrics

本文评价

[1]	梁贇, 吉顺荣, 虞先濬, 陈洁. 神经内分泌肿瘤药物临床试验进展[J]. 中国癌症杂志, 2022, 32(9): 757-764.
[2]	王先泽, 吴文铭. 胰腺神经内分泌肿瘤外科治疗理念的四种转变[J]. 中国癌症杂志, 2022, 32(9): 765-771.
[3]	高鹤丽, 徐近, 虞先濬. 2021年胰腺神经内分泌肿瘤诊治的新进展[J]. 中国癌症杂志, 2022, 32(9): 772-778.
[4]	崔灵珺, 田超, 程梓轩, 郑佳彬, 苏菲, 谭煌英. 胃肠胰神经内分泌肿瘤临床前模型的研究进展[J]. 中国癌症杂志, 2022, 32(9): 779-785.
[5]	郑秀丽, 姚志原, 吴明利, 尔丽绵, 李胜棉. 直肠神经内分泌肿瘤淋巴结转移的危险因素分析及内镜切除方式比较[J]. 中国癌症杂志, 2022, 32(9): 800-806.
[6]	中国抗癌协会神经内分泌肿瘤专业委员会. 中国抗癌协会神经内分泌肿瘤诊治指南（2022年版）[J]. 中国癌症杂志, 2022, 32(6): 545-579.
[7]	郭文婷, 慕转转, 李征, 张迎强, 靳晓娜, 林岩松. 可疑甲状腺球蛋白增高性分化型甲状腺癌患者经¹³¹I治疗后的临床转归[J]. 中国癌症杂志, 2022, 32(5): 410-416.
[8]	陆　立, 卢仁泉, 孙佳俊, 陆　凝, 郭　林. 血清N-MID在原发性肺癌患者骨转移辅助诊断和疗效监测中的应用分析[J]. 中国癌症杂志, 2021, 31(9): 838-844.
[9]	义维丽, 赵文成, 黄东宁, 覃　莉, 吴新天, 周　斐, 吴凤英 . PD-1单抗治疗非小细胞肺癌相关不良反应及其与疗效的相关性分析[J]. 中国癌症杂志, 2021, 31(3): 203-211.
[10]	武鸿文, 梅　艳, 王　乔, 袁　佳, 赵立威. 血清MIP-1α、S-TK1对于甲状腺癌术后放射性 ¹³¹ I治疗效果评估的临床价值[J]. 中国癌症杂志, 2021, 31(11): 1088-1095.
[11]	宁周雨, 花永强, 徐立涛, 庄丽萍, 冯兰云, 陈　颢, 王　鹏, 沈晔华, 林钧华, 陈　震, 孟志强. 白蛋白结合型紫杉醇联合吉西他滨动脉灌注治疗进展期胰腺癌的安全性和有效性回顾性研究[J]. 中国癌症杂志, 2020, 30(2): 128-134.
[12]	胡　磊, 董红军, 徐　浩, 袁毅方, 王耀华 . 喉部分切除术和经口内镜CO ₂ 激光显微手术治疗前联合阳性早期声门癌患者的疗效比较[J]. 中国癌症杂志, 2020, 30(2): 142-147.
[13]	方瑜佳, 周　娟, 苏春霞. 非小细胞肺癌肝转移免疫微环境及未来干预策略[J]. 中国癌症杂志, 2020, 30(10): 750-758.
[14]	孙健达，熊俊，张汉雄，陈意标. 血液标志物在局部晚期鼻咽癌中的预测价值[J]. 中国癌症杂志, 2019, 29(7): 528-534.
[15]	李静文，周　严，曹淑慧，王　悦，钟　华. 纳武单抗对晚期非小细胞肺癌的疗效和安全性的单中心分析[J]. 中国癌症杂志, 2019, 29(10): 803-808.