| Part 1 DEB-TACE for the treatment of hepatocellular carcinoma failed / refractory to c TACEObjectiveTo evaluate the efficacy and safety of transarterial chemoembolization using drug-eluting bead(DEB-TACE)in the treatment of hepatocellular carcinoma(HCC)with failed/refractory transarterial chemoembolization(TACE),and to explore the influencing factors of efficacy.MethodsA total of 47 HCC patients with TACE failure/refractory who received DEB-TACE from May 1,2016 to March 31,2020 in our hospital were retrospectively analyzed.Imaging evaluation was performed according to the modified Response Evaluation Criteria in Solid Tumors(m RECIST)at 4-8 weeks after treatment,and survival curves were plotted using the Kaplan-Meier method by SPSS version 22.0 software to count the 1-year,2-year,and 3-year survival rates of HCC patients with TACE failure/resistance after DEB-TACE treatment.The adverse events after treatment were recorded.The Visual Analogue Scale(VAS)was used to assess the degree of pain after treatment.The degree of fever and vomiting after treatment was assessed according to the Common Terminology Criteria for Adverse Events(CTCAE)version 4.0.The laboratory test data before and 3 days after operation were recorded and compared.ResultsOf the 47 patients,19(40.4%)achieved complete response(CR)and 36(76.6%)achieved objective response after DEB-TACE.The cumulative survival rates at 1,2,and 3years were 85.3%,63.5%,and 59.6%,respectively.Multivariate logistic regression analysis showed that age ≥ 60(P = 0.020,odd ratio [OR] = 5.420,95% confidence interval[CI]: 1.302-22.568),tumor ≥ 5 cm(P = 0.036,OR = 0.224,95% CI: 0.055-0.905)affected CR.The cumulative survival rates of 1,2 and 3 years were 85.3%,63.5% and59.6%,respectively.All patients(n = 47)had some injuries of liver function after treatment.The incidences of abdominal pain,fever and vomiting after DEB-TACE were 57.4%,17.0% and 8.5% respectively.ConclusionDEB-TACE is safe and effective in the treatment of TACE failed/refractory HCC,and the efficacy may be related to age and tumor size.Part2 DEB-TACE for the treatment of unresectable intrahepatic cholangiocarcinomaObjectiveTo compare the efficacy and safety of DEB-TACE and Conventional transarterial chemoembolization(c TACE)in the treatment of Intrahepatic cholangiocarcinoma(ICC).MethodsA total of 35 patients with ICC from May 1,2016 to December 31,2020 in our hospital were retrospectively analyzed,among whom 17 patients received DEB-TACE and 18 patients received c TACE.Imaging evaluation was performed according to the Response Evaluation Criteria in Solid Tumors(RECIST)at 4-8 weeks after surgery,and the efficacy was compared between the two groups.The survival curve was drawn by SPSS 22.0 software using Kaplan-Meier method,and the survival of the two groups after treatment was statistically analyzed and compared.The adverse events of patients in the two groups after treatment were recorded and compared.The degree of pain after treatment was assessed by VAS,while the severity of vomiting and fever after treatment was evaluated according to CTCAE version 4.0.Preoperative and postoperative laboratory data were recorded,and liver function was compared between the two groups 3 days after treatment.ResultsAmong 17 patients in DEB-TACE group,3 patients(17.6%)achieved CR,7 patients(41.2%)achieved PR,6 patients(35.3%)were assessed as SD,and 1 patient(5.9%)had PD.Among 18 patients in c TACE group,3 patients(16.7%)achieved PR,13 patients(72.2%)achieved SD and 2 patients(11.1%)achieved PD.The overall tumor objective response rate(ORR)in the DEB-TACE group was significantly higher than that in the c TACE group(58.8% VS 16.7%,P = 0.012),while the overall disease control rate(DCR)was not significantly different between the two groups(94.1% VS 88.9%,P = 1.000).The 1-year and 2-year survival rates were 57.8% and 27.1% in the DEB-TACE group,and 45.8% and 27.5% in the c TACE group,respectively.The median survival time in the DEB-TACE group was 14(9,30)months,and the median survival time in the c TACE group was 12(8,27)months,P=0.728.Twenty-six of 35 patients(74.3%)had post-embolization syndrome after treatment,including 16 patients(94.1%)in DEB-TACE group and 10 patients(55.6%)in c TACE group,P = 0.026.The incidence of abdominal pain was significantly higher in the DEB-TACE group than in the c TACE group(94.1% VS 44.4%,P = 0.002).The patients in the two groups had different degrees of liver function injury after treatment,and the difference had no statistical significance.ConclusionDEB-TACE is safe and effective in the treatment of ICC,and the short-term efficacy may be superior to c TACE.The incidence of abdominal pain was higher in patients after DEB-TACE treatment.Part3 DEB-TACE for the treatment of liver metastases from colorectal cancer after resectionObjectiveTo compare the efficacy and safety of DEB-TACE and c TACE in the treatment of postoperative colorectal liver metastases(CLM),and to explore the influencing factors of efficacy.MethodsA total of 77 patients with CLM from March 1,2016 to December 31,2020 in our hospital were retrospectively analyzed,among whom 35 patients received DEB-TACE and 42 patients received c TACE.Imaging assessment was performed according to RECIST criteria 4-8 weeks after treatment,and the efficacy was compared between the two groups.The survival curve was drawn by SPSS 22.0 software using Kaplan-Meier method,and the survival of the two groups after treatment was statistically analyzed and compared.The adverse events of patients in the two groups after treatment were recorded and compared.The degree of pain after treatment was assessed by VAS,while the severity of vomiting and fever after treatment was evaluated according to CTCAE version 4.0.Preoperative and postoperative laboratory data were recorded,and liver function was compared between the two groups 3 days after treatment.ResultsAmong 35 patients in DEB-TACE group,3 patients(8.6%)achieved CR,20 patients(57.1%)achieved PR,11 patients(31.4%)were assessed as SD and 1 patient(2.9%)was assessed as PD.Among 42 patients in c TACE group,1 patient(2.4%)achieved CR,7 patients(16.7%)achieved PR,26 patients(61.9%)achieved SD and 8 patients(19.0%)achieved PD.The overall ORR in DEB-TACE group was significantly higher than that in c TACE group(65.7% VS 19.0%,P < 0.001),while the overall DCR was similar between the two groups(97.1% VS 81.0%,P = 0.065).Multivariate logistic regression analysis showed that overall ORR was associated with the type of TACE.The 1-year and 2-year survival rates were 87.1% and 48.7% in DEB-TACE group,67.8% and 23.4% in c TACE group.The median survival time of DEB-TACE group and c TACE group was 15(10,24)months and 24(19,36)months,respectively(P = 0.012).52/77 patients(67.5%)had post-embolization syndrome after treatment,including 28 cases(80.0%)in DEB-TACE group and 24 cases(57.2%)in c TACE group,P = 0.033.The most common post-embolization syndrome was abdominal pain,25 patients(77.1%)in DEB-TACE group and 23 patients(54.7%)in c TACE group,P = 0.040.Vomiting occurred in 8 patients(22.9%)in DEB-TACE group and 10 patients(23.8%)in c TACE group,P = 0.922.However,the fever rate in DEB-TACE group was significantly lower than that in c TACE group(0VS 28.5%,P = 0.001).All patients had different degrees of liver function injury,and the liver function injury after treatment in the DEB-TACE group was milder than that in the c TACE group.Two patients with DEB-TACE had mild biliary tract injury,which did not require treatment.ConclusionDEB-TACE is safe and effective in the treatment of CLM.Compared with c TACE,DEB-TACE may have better short-term efficacy in the treatment of CLM,and less damage to liver function,but the incidence of postembolization syndrome is higher than that of c TACE. |
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