ISSN: 1859 - 2872
Kết quả sống thêm lâu dài ở bệnh nhân ung thư biểu mô tế bào gan điều trị bằng tắc mạch hoá chất qua đường động mạch
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Keywords
Ung thư biểu mô tế bào gan, tắc mạch hoá chất qua đường động mạch, tiên lượng sống, đáp ứng khối u
Tóm tắt
Mục tiêu: Đánh giá hiệu quả điều trị tắc mạch hoá chất qua đường động mạch và các yếu tố tiên lượng ảnh hưởng đến sống còn ở bệnh nhân ung thư biểu mô tế bào gan. Đối tượng và phương pháp: Nghiên cứu hồi cứu trên 477 bệnh nhân ung thư biểu mô tế bào gan điều trị bằng tắc mạch hoá chất qua đường động mạch. Thời gian sống thêm được tính bằng phương pháp Kaplan-Meier, đánh giá các yếu tố tiên lượng ảnh hưởng đến sống còn toàn bộ dựa vào kiểm định Log-rank và mô hình Cox. Kết quả: Tổng số có 477 bệnh nhân (437 nam, 40 nữ, tuổi trung bình 61,1 ± 11,7 năm), trung vị thời gian theo dõi 25,3 (1-63) tháng. Đáp ứng khối u theo mRECIST thời điểm 6 tháng gồm đáp ứng hoàn toàn 41 bệnh nhân (8,7%), đáp ứng một phần 352 (74,9%), bệnh ổn định/tiến triển 77 (16,1%). Trung vị sống thêm toàn bộ 53 ± 1,1 tháng. Các yếu tố ảnh hưởng đến sống thêm toàn bộ gồm ECOG ≤ 1, điểm Child-Pugh A, giai đoạn BCLC A/B, có đáp ứng điều trị khối u, điểm ALBI độ I. Trong phân tích đa biến, đáp ứng khối u và điểm Child-Pugh A là yếu tố có ý nghĩa tiên lượng sống thêm toàn bộ dài hơn. Kết luận: Tắc mạch hoá chất qua đường động mạch là phương pháp điều trị hiệu quả ở bệnh nhân ung thư gan. Chức năng gan Child-Pugh A và có đáp ứng khối u là yếu tố tiên lượng tốt đối với sống thêm toàn bộ.
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Các tài liệu tham khảo
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4. Shi Q, Liu J, Li T, Zhou C, Wang Y, Huang S, Yang C, Chen Y, Xiong B (2022) Comparison of DEB-TACE and cTACE for the initial treatment of unresectable hepatocellular carcinoma beyond up-to-seven criteria: A single-center propensity score matching analysis. Clinics and research in hepatology and gastroenterology 46(5): 101893. https://doi.org/ 10.1016/j.clinre.2022.101893.
5. Wang YY, Zhong JH, Xu HF, Xu G, Wang LJ, Xu D, Wang HW, Wang K, Xiang BD, Mao YL, Li LQ, & Xing BC (2019) A modified staging of early and intermediate hepatocellular carcinoma based on single tumour > 7 cm and multiple tumours beyond up-to-seven criteria. Alimentary pharmacology & therapeutics 49(2): 202-210. https://doi.org/10. 1111/apt.15074.
6. Lo CM, Ngan H, Tso WK et al (2002) Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 35: 1164-1171.
7. Llovet JM, Real MI, Montaña X et al (2002) Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: A randomised controlled trial. Lancet 359: 1734-1739.
8. Cammà C, Schepis F, Orlando A et al (2002) Transarterial chemoembolization for unresectable hepatocellular carcinoma: Meta-analysis of randomized controlled trials. Radiology 224: 47-54.
9. Lencioni R, Llovet J (2010) Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Seminars in Liver Disease 30(01): 52-60.
10. Chang Y, Jeong SW, Young Jang J, & Jae Kim Y (2020) Recent updates of transarterial chemoembolilzation in hepatocellular carcinoma. International journal of molecular sciences 21(21): 8165. https://doi.org/10.3390/ ijms21218165
11. Facciorusso A, Di Maso M, Muscatiello N (2016) Drug-eluting beads versus conventional chemoembolization for the treatment of unresectable hepatocellular carcinoma: A meta-analysis. Dig. Liver Dis. 48: 571-577. doi: 10.1016/j. dld.2016.02.005.
12. Yau T, Tang VY, Yao TJ, Fan ST, Lo CM, Poon RT (2014) Development of Hong Kong Liver Cancer staging system with treatment stratification for patients with hepatocellular carcinoma. Gastroenterology 146: 1691-1700. doi: 10.1053/j. gastro.2014.02.032.
13. Li J, Wang N, Shi C, Liu Q, Song J, Ye X (2021) Short-term efficacy and safety of callispheres drug-loaded microsphere embolization in primary hepatocellular carcinoma. Journal of cancer research and therapeutics 17(3): 733-739. https://doi.org/10. 4103/jcrt.JCRT_1848_20.
14. Lee M, Chung JW, Lee KH, Won JY, Chun HJ, Lee H C, Kim JH, Lee IJ, Hur S, Kim HC, Kim YJ, Kim GM, Joo SM, Oh JS (2017) Korean Multicenter Registry of transcatheter arterial chemoembolization with drug-eluting embolic agents for nodular hepatocellular carcinomas: Six-month outcome analysis. Journal of vascular and interventional radiology: JVIR 28(4): 502-512. https://doi.org/10.1016/j.jvir.2016.08.017.
15. Affonso BB, Galastri FL, da Motta Leal Filho JM, Nasser F, Falsarella PM, Cavalcante RN, de Almeida MD, Felga G, Valle L, Wolosker N (2019) Long-term outcomes of hepatocellular carcinoma that underwent chemoembolization for bridging or downstaging. World journal of gastroenterology 25(37): 5687-5701. https://doi.org/10.3748/ wjg.v25.i37.5687.
16. Mukund A, Bhardwaj K, Choudhury A, Sarin SK (2021) Survival and outcome in patients receiving drug-eluting beads transarterial chemoembolization for large hepatocellular carcinoma (> 5cm). Journal of clinical and experimental hepatology 11(6): 674-681. https://doi.org/10.1016/j.jceh.2021.02.003.
17. Malagari K, Pomoni M, Moschouris H, Bouma E, Koskinas J, Stefaniotou A, Marinis A, Kelekis A, Alexopoulou E, Chatziioannou A, Chatzimichael K, Dourakis S, Kelekis N, Rizos S, Kelekis D (2012) Chemoembolization with doxorubicin-eluting beads for unresectable hepatocellular carcinoma: five-year survival analysis. Cardiovascular and interventional radiology 35(5): 1119-1128. https://doi.org/10. 1007/s00270-012-0394-0.
18. Song MJ, Chun HJ, Song DS, Kim HY, Yoo SH, Park, CH, Bae SH, Choi, JY, Chang UI, Yang JM, Lee HG, Yoon SK (2012) Comparative study between doxorubicin-eluting beads and conventional transarterial chemoembolization for treatment of hepatocellular carcinoma. Journal of hepatology: 57(6): 1244-1250. https://doi.org/10.1016/j.jhep. 2012.07.017.
19. Golfieri R, Giampalma E, Renzulli M, Cioni R, Bargellini I, Bartolozzi C, Breatta AD, Gandini G, Nani R, Gasparini D, Cucchetti A, Bolondi L, Trevisani F and Precision Italia Study Group (2014) Randomised controlled trial of doxorubicin-eluting beads vs conventional chemoembolisation for hepatocellular carcinoma. British journal of cancer 111(2): 255-264. https://doi.org/10.1038/ bjc.2014.199.
20. Demirtas CO, D'Alessio A, Rimassa L, Sharma R, & Pinato DJ (2021) ALBI grade: Evidence for an improved model for liver functional estimation in patients with hepatocellular carcinoma. JHEP reports: Innovation in hepatology 3(5): 100347. https://doi.org/10.1016/j.jhepr.2021.100347.
21. Dhanasekaran R, Kooby DA, Staley CA, Kauh JS, Khanna V & Kim HS (2010) Prognostic factors for survival in patients with unresectable hepatocellular carcinoma undergoing chemoembolization with doxorubicin drug-eluting beads: A preliminary study. HPB : The official journal of the International Hepato Pancreato Biliary Association 12(3): 174-180. https://doi.org/10.1111/j.1477-2574.2009.00138.x.
22. Kalva SP, Pectasides M, Yeddula K, Ganguli S, Blaszkowsky LS & Zhu AX (2013) Factors affecting survival following chemoembolization with doxorubicin-eluting microspheres for inoperable hepatocellular carcinoma. Journal of vascular and interventional radiology: JVIR 24(2): 257-265. https://doi.org/10.1016/j.jvir.2012.10.021.
2. Zhang CH, Cheng Y, Zhang S, Fan J, Gao Q (2022) Changing epidemiology of hepatocellular carcinoma in Asia. Liver international: Official journal of the International Association for the Study of the Liver. Advance online publication. https://doi.org/10.1111/liv.15251.
3. Yang JD, Heimbach JK (2020) New advances in the diagnosis and management of hepatocellular carcinoma. BMJ (Clinical research ed.) 371: 3544. https://doi.org/10.1136/bmj.m3544.
4. Shi Q, Liu J, Li T, Zhou C, Wang Y, Huang S, Yang C, Chen Y, Xiong B (2022) Comparison of DEB-TACE and cTACE for the initial treatment of unresectable hepatocellular carcinoma beyond up-to-seven criteria: A single-center propensity score matching analysis. Clinics and research in hepatology and gastroenterology 46(5): 101893. https://doi.org/ 10.1016/j.clinre.2022.101893.
5. Wang YY, Zhong JH, Xu HF, Xu G, Wang LJ, Xu D, Wang HW, Wang K, Xiang BD, Mao YL, Li LQ, & Xing BC (2019) A modified staging of early and intermediate hepatocellular carcinoma based on single tumour > 7 cm and multiple tumours beyond up-to-seven criteria. Alimentary pharmacology & therapeutics 49(2): 202-210. https://doi.org/10. 1111/apt.15074.
6. Lo CM, Ngan H, Tso WK et al (2002) Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 35: 1164-1171.
7. Llovet JM, Real MI, Montaña X et al (2002) Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: A randomised controlled trial. Lancet 359: 1734-1739.
8. Cammà C, Schepis F, Orlando A et al (2002) Transarterial chemoembolization for unresectable hepatocellular carcinoma: Meta-analysis of randomized controlled trials. Radiology 224: 47-54.
9. Lencioni R, Llovet J (2010) Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Seminars in Liver Disease 30(01): 52-60.
10. Chang Y, Jeong SW, Young Jang J, & Jae Kim Y (2020) Recent updates of transarterial chemoembolilzation in hepatocellular carcinoma. International journal of molecular sciences 21(21): 8165. https://doi.org/10.3390/ ijms21218165
11. Facciorusso A, Di Maso M, Muscatiello N (2016) Drug-eluting beads versus conventional chemoembolization for the treatment of unresectable hepatocellular carcinoma: A meta-analysis. Dig. Liver Dis. 48: 571-577. doi: 10.1016/j. dld.2016.02.005.
12. Yau T, Tang VY, Yao TJ, Fan ST, Lo CM, Poon RT (2014) Development of Hong Kong Liver Cancer staging system with treatment stratification for patients with hepatocellular carcinoma. Gastroenterology 146: 1691-1700. doi: 10.1053/j. gastro.2014.02.032.
13. Li J, Wang N, Shi C, Liu Q, Song J, Ye X (2021) Short-term efficacy and safety of callispheres drug-loaded microsphere embolization in primary hepatocellular carcinoma. Journal of cancer research and therapeutics 17(3): 733-739. https://doi.org/10. 4103/jcrt.JCRT_1848_20.
14. Lee M, Chung JW, Lee KH, Won JY, Chun HJ, Lee H C, Kim JH, Lee IJ, Hur S, Kim HC, Kim YJ, Kim GM, Joo SM, Oh JS (2017) Korean Multicenter Registry of transcatheter arterial chemoembolization with drug-eluting embolic agents for nodular hepatocellular carcinomas: Six-month outcome analysis. Journal of vascular and interventional radiology: JVIR 28(4): 502-512. https://doi.org/10.1016/j.jvir.2016.08.017.
15. Affonso BB, Galastri FL, da Motta Leal Filho JM, Nasser F, Falsarella PM, Cavalcante RN, de Almeida MD, Felga G, Valle L, Wolosker N (2019) Long-term outcomes of hepatocellular carcinoma that underwent chemoembolization for bridging or downstaging. World journal of gastroenterology 25(37): 5687-5701. https://doi.org/10.3748/ wjg.v25.i37.5687.
16. Mukund A, Bhardwaj K, Choudhury A, Sarin SK (2021) Survival and outcome in patients receiving drug-eluting beads transarterial chemoembolization for large hepatocellular carcinoma (> 5cm). Journal of clinical and experimental hepatology 11(6): 674-681. https://doi.org/10.1016/j.jceh.2021.02.003.
17. Malagari K, Pomoni M, Moschouris H, Bouma E, Koskinas J, Stefaniotou A, Marinis A, Kelekis A, Alexopoulou E, Chatziioannou A, Chatzimichael K, Dourakis S, Kelekis N, Rizos S, Kelekis D (2012) Chemoembolization with doxorubicin-eluting beads for unresectable hepatocellular carcinoma: five-year survival analysis. Cardiovascular and interventional radiology 35(5): 1119-1128. https://doi.org/10. 1007/s00270-012-0394-0.
18. Song MJ, Chun HJ, Song DS, Kim HY, Yoo SH, Park, CH, Bae SH, Choi, JY, Chang UI, Yang JM, Lee HG, Yoon SK (2012) Comparative study between doxorubicin-eluting beads and conventional transarterial chemoembolization for treatment of hepatocellular carcinoma. Journal of hepatology: 57(6): 1244-1250. https://doi.org/10.1016/j.jhep. 2012.07.017.
19. Golfieri R, Giampalma E, Renzulli M, Cioni R, Bargellini I, Bartolozzi C, Breatta AD, Gandini G, Nani R, Gasparini D, Cucchetti A, Bolondi L, Trevisani F and Precision Italia Study Group (2014) Randomised controlled trial of doxorubicin-eluting beads vs conventional chemoembolisation for hepatocellular carcinoma. British journal of cancer 111(2): 255-264. https://doi.org/10.1038/ bjc.2014.199.
20. Demirtas CO, D'Alessio A, Rimassa L, Sharma R, & Pinato DJ (2021) ALBI grade: Evidence for an improved model for liver functional estimation in patients with hepatocellular carcinoma. JHEP reports: Innovation in hepatology 3(5): 100347. https://doi.org/10.1016/j.jhepr.2021.100347.
21. Dhanasekaran R, Kooby DA, Staley CA, Kauh JS, Khanna V & Kim HS (2010) Prognostic factors for survival in patients with unresectable hepatocellular carcinoma undergoing chemoembolization with doxorubicin drug-eluting beads: A preliminary study. HPB : The official journal of the International Hepato Pancreato Biliary Association 12(3): 174-180. https://doi.org/10.1111/j.1477-2574.2009.00138.x.
22. Kalva SP, Pectasides M, Yeddula K, Ganguli S, Blaszkowsky LS & Zhu AX (2013) Factors affecting survival following chemoembolization with doxorubicin-eluting microspheres for inoperable hepatocellular carcinoma. Journal of vascular and interventional radiology: JVIR 24(2): 257-265. https://doi.org/10.1016/j.jvir.2012.10.021.
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TháiN. V., MạnhN. V., TuyếtT. T. Ánh, Giang Đinh T., TuấnN. A., Loan Đoàn M., TrangN. T. H., BìnhM. T., ThanhT. V., HoàiM. T., LiênN. T. P., HoáN. V., HưngV. Q., HùngT. X., & ThịnhN. T. (2022). Kết quả sống thêm lâu dài ở bệnh nhân ung thư biểu mô tế bào gan điều trị bằng tắc mạch hoá chất qua đường động mạch. Journal of 108 - Clinical Medicine and Phamarcy, 17(6). https://doi.org/10.52389/ydls.v17i6.1386