摘要
经动脉化疗栓塞(transarterial chemoembolization,TACE)是目前治疗肝细胞癌(hepatocellular carcinoma,HCC)最常用方法之一。然而,重复进行无效的TACE治疗可能会加重肝功能损伤,影响患者预后。“TACE抵抗(TACE failure/refractoriness)”这一概念,即是在此背景下为避免进行重复无效的TACE治疗而提出的。但已有的多个“TACE抵抗”定义彼此间尚存在分歧,且均存在一定的局限性,对中国HCC人群是否适用也有待商榷。由中国医师协会介入医师分会(Chinese College of Interventionalists,CCI)成立的“TACE抵抗”协作组结合现有的循证医学证据及国内专家意见,于2021年提出了符合中国临床实践的“TACE抵抗”CCI定义及专家共识。“TACE抵抗”定义为:经过连续3次及以上规范化、精细化TACE治疗后,末次术后1~3个月内通过增强CT/MRI检查并基于mRECIST标准进行评估,若肝内靶病灶与首次TACE治疗前相比仍处于疾病进展状态,则为发生“TACE抵抗”,须及时终止再次TACE而转换为其他治疗。本共识的发布旨在使“TACE抵抗”概念更具科学性,从而更好地指导临床实践,进一步提高中国HCC患者TACE治疗受益率。
Transarterial chemoembolization(TACE)is the fundamental method for the treatment of unresectable hepatocellular carcinoma(HCC).However,ineffective and repeated TACE procedures may aggravate the liver function damage and cause negative effect on long-term prognosis of HCC patients.The concept of“TACE resistance(TACE failure/refractoriness)”was proposed in this context in order to avoid repeated and ineffective TACE treatment.There are disagreements between the multiple definitions of“TACE failure/refractoriness”already proposed.All these definitions have some limitations,moreover,whether these definitions are applicable to the Chinese HCC population is also questionable.Referring to the existing evidence-based clinical achievements and domestic expert opinions,in 2021 the“TACE failure/refractoriness”Collaboration Group formed by Chinese College of Interventionalists(CCI)proposed the CCI definition and expert consensus of“TACE failure/refractoriness”in accordance with the clinical practice in China.The“TACE failure/refractoriness”is defined as follows:after three or more consecutive standardized and refined TACE treatments,the intrahepatic target lesion still remains in a disease progression state when compared with preoperative state which is evaluated by enhanced CT/MRI examination performed within 1-3 months after the last TACE procedure and is based on mRECIST criteria.At this point,TACE treatment must be promptly terminated and the patient should be treated with other therapies.This consensus aims to make the concept of“TACE failure/refractoriness”more scientific,and,thus,to better guide clinical practice and further improve the benefit rate of Chinese HCC patients receiving TACE treatment.(J Intervent Radiol,2022,31:1039-1044)
出处
《介入放射学杂志》
CSCD
北大核心
2022年第11期1039-1044,共6页
Journal of Interventional Radiology
基金
国家自然科学基金青年科学基金(81901847)。
关键词
癌
肝细胞
栓塞
治疗性
经动脉化疗栓塞
抵抗
专家共识
carcinoma
hepatocellular
embolization
therapeutic
transarterial chemoembolization
refractoriness
expert consensus
