Precizna hemoembolizacija hipovaskularnog hepatocelularnog karcinoma vođena kompjuterizovanom tomografijom konusnog zraka
Sažetak
Uvod/Cij. Hipovaskularni hepatocelularni karcinom (hepatocellular carcinoma – HCC) i dalje predstavlja terapijski izazov zbog nedovoljne arterijske vaskularizacije i slabog odgovora na standardnu transarterijsku hemoembolizaciju (transarterial chemoembolization – TACE). Cilj rada bio je da se procene klinička efikasnost i bezbednost precizne TACE vođene trodimenzionalnim (3D) snimanjem pomoću kompjuterizovane tomografije konusnog zraka (cone-beam computed tomography – CBCT) u odnosu na konvencionalnu TACE vođenu digitalnom subtrakcionom angiografijom (DSA) u lečenju hipovaskularnog HCC. Metode. Retrospektivnom studijom obuhvaćeni su oboleli od hipovaskularnog HCC i koji su bili podvrgnuti TACE proceduri u našoj ustanovi u periodu od januara 2020. do decembra 2023. godine. Korišćenjem metode uparivanja na osnovu skora sklonosti (propensity score matching – PSM) u odnosu 1 : 1, po 58 bolesnika raspoređena su u svaku od dve grupe: grupu preciznog TACE vođenog CBCT (grupa CBCT) i grupu konvencionalnog TACE vođenog DSA (grupa DSA). Kovarijate podudarnosti obuhvatile su životno doba, pol, Child-Pugh stepen, veličinu i broj tumora. Upoređeni su kratkoročna efikasnost, dugoročno preživljavanje i bezbednosni profil između ove dve grupe. Rezultati. Tri meseca nakon procedure, u grupi CBCT zabeležene su znatno viša stopa objektivnog odgovora (63,79% vs. 36,21%) i stopa kontrole bolesti (86,21% vs. 68,97%) u poređenju sa grupom DSA (p < 0,05). U pogledu dugoročnog preživljavanja, grupa CBCT imala je značajno dužu medijanu preživljavanja bez progresije bolesti (10,80 meseci vs. 7,10 meseci) kao i višu jednogodišnju stopu preživljavanja bez progresije bolesti (65,52% vs. 41,38%) u poređenju sa grupom DSA (p < 0,05). Međutim, nisu primećene statistički značajne razlike između grupa CBCT i DSA za medijanu ukupnog preživljavanja (22,50 meseci vs. 19,10 meseci), niti za jednogodišnju stopu ukupnog preživljavanja (81,03% vs. 72,41%) (p > 0,05). Učestalost postembolizacijskog sindroma i teških komplikacija (npr. apsces jetre, insuficijencija jetre) nije se značajno razlikovala između grupa (p > 0,05). Primećeno je da je porast nivoa alanin aminotransferaze trećeg dana posle operacije bio znatno niži u grupi CBCT nego u grupi DSA (p = 0,016). Zaključak. Precizna TACE vođena 3D CBCT snimanjem značajno poboljšava kratkoročnu terapijsku efikasnost, produžava preživljavanje bez progresije bolesti i obezbeđuje bolju zaštitu jetre bez povećanja rizika od procedure, čime se potvrđuje kao bezbedan i efikasan interventni terapijski izbor za lečenje hipovaskularnog HCC.
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