胰腺癌肝转移的介入治疗

  目的  评价经肝动脉化疗栓塞及胰腺动脉局部灌注化疗对胰腺癌肝转移的反应率、生存时间以及术后影响患者生存的主要因素。  方法  2002年1月至2011年6月对125例胰腺癌伴肝转移患者进行了265次介入治疗（所有患者均联合胰腺病灶放疗）。包括肝动脉化疗栓塞+胰腺动脉灌注化疗220例次, 桡动脉留置导管持续胰腺动脉灌注化疗45例次。通过影像学资料观察肿瘤对介入治疗的反应, 分析患者术后的生存时间, 肿瘤无进展生存时间。调查患者临床特征、肿瘤大小和治疗等各种因素对患者生存的影响。  结果  125例患者进行了265次介入治疗, 对其中105例患者影像学资料进行分析, 12例患者肿瘤对治疗有部分反应, 17例患者对治疗有轻微反应, 68例患者肿瘤无明显变化, 8例患者肿瘤进展。平均生存时间和无进展生存时间分别为6.7个月和3.8个月。多因素回归分析显示: 肿瘤>肝脏体积的75%和乳酸脱氢酶浓度影响术后患者的生存时间。若患者对介入反应良好, 则生存时间也会相应延长。  结论  介入治疗可以使胰腺癌肝转移患者肿瘤缩小, 病情稳定。其中肿瘤大小、乳酸脱氢酶浓度和对肿瘤对治疗的反应性是影响患者生存率的主要因素。 

Hepatic Artery Chemoembolization in Patients with Liver Metastasis from Pancreatic Carcinoma

  Objective  To evaluate response rates and survival durations after hepatic arterial chemoembolization (HACE) in patients with liver metastasis from pancreatic carcinoma, and to analyze factors affecting patient survival.  Methods  The medical records of patients with liver metastasis from pancreatic carcinoma who underwent HACE at the general hospital of Chinese People's Liberation Army from 2002 to 2011 were reviewed. The radiologic tumor response rates, overall survival (OS), and progression-free survival durations were calculated. Patient, tumor, and treatment variables were analyzed to identify factors influencing survival.  Results  One hundred and twenty-five patients underwent 265 HACE sessions. Of the 105 patients in whom radiologic responses could be evaluated, 12 (11%) had partial responses, 17 (16%) had minor responses, 68 (65%) had stable diseases, and 8 (8%) had progressive diseases. The median OS and progression-free survival durations were 6.7 months and 3.8 months, respectively. Multivariate analysis showed that >75% liver involvement and high lactate dehydrogenase levels were associated with short OS. Patients who had radiologic responses to HACE had a longer median OS duration than patients who did not (15.8 months vs. 6.1 months; P = 0.0005). Patients with > 75% liver involvement had a median OS duration of only 2.4 months.  Conclusion  HACE resulted in radiologic response or disease stabilization in most patients with liver metastasis from pancreatic carcinoma. The extent of liver involvement, baseline lactate dehydrogenase levels, and response to therapy were found to be significant predictors of OS after HACE.