Radioembolization Is a Safe and Effective Treatment for Hepatocellular Carcinoma with Portal Vein Thrombosis: A Propensity Score Analysis.
Radioembolization Is a Safe and Effective Treatment for Hepatocellular Carcinoma with Portal Vein Thrombosis: A Propensity Score Analysis.
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DOI：
10.1371/journal.pone.0154986
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Kim YJ
中科院分区：
文献类型：
--
作者：
Cho YY;Lee M;Kim HC;Chung JW;Kim YH;Gwak GY;Bae SH;Kim do Y;Heo J;Kim YJ
有门静脉血栓形成(PVT)的肝细胞癌(HCC)患者的治疗选择有限。用~(90)Y微球行肝动脉放射栓塞术是治疗肝细胞癌合并门静脉血栓的一种新方法。在这项分析中，我们比较了放射栓塞术和索拉非尼治疗的反应。我们评估了32名患者，他们是多中心回顾队列的一部分。所有患者都有门静脉血栓，没有肝外转移，并在韩国六家三级转诊医院之一接受了放射栓塞术。我们回顾性地招募了另外31名连续接受索拉非尼治疗的无肝外转移的PVT患者作为对照组。我们使用逆概率加权(IPW)，使用倾向性分数来调整组间基线特征的差异。3个月时放射栓塞组有效率为32.1%(9/32)，疾病控制率为57.1%(16/32)；索拉非尼组有效率为3.2%(1/31)，疾病控制率为41.9%(13/31)。放射栓塞组和索拉非尼组的中位总生存期(OS)和进展时间(TTP)分别为13.8个月和10.0个月(P=0.22；6.0个月和6.0个月，P=0.08)。应用IPW平衡种群特征后，OS(P=0.97)和TTP(P=0.34)差异无统计学意义。索拉非尼组的3/4级不良反应明显多于放射栓塞组(P<；0.01)。接受放射栓塞术的肝细胞癌合并PVT患者的存活率与接受索拉非尼的患者相当，即使在应用IPW后也是如此。放射栓塞组的严重不良反应也较少。放射栓塞术可以被认为是肝癌合并PVT患者的一种新的治疗选择。
Limited treatment options are available for patients with hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT). Transarterial radioembolization using Yttrium-90 microspheres is a new treatment modality for HCC with PVT. For this analysis, we compared responses to treatment with radioembolization and with sorafenib. We evaluated 32 patients who were part of a multicenter retrospective cohort. All patients had PVT without extrahepatic metastasis and were treated with radioembolization in one of six tertiary referral hospitals in Korea. We retrospectively enrolled another 31 consecutive PVT patients without extrahepatic metastasis from a single center who received sorafenib treatment to serve as the control group. We used inverse probability weighting (IPW) using propensity scores to adjust for the between-group differences in baseline characteristics. At 3 months, the response rate and disease control rate were 32.1% (9/32) and 57.1% (16/32), respectively, in the radioembolization group and 3.2% (1/31) and 41.9% (13/31) in the sorafenib group. Median overall survival (OS) and time to progression (TTP) were not significantly different between the radioembolization group and the sorafenib group (13.8 months and 10.0 months, P = 0.22; and 6.0 months and 6.0 months, P = 0.08; respectively). No differences in OS (P = 0.97) or TTP (P = 0.34) were observed after IPW was applied to balance the population characteristics. The sorafenib group showed significantly more grade 3/4 adverse effects than the radioembolization group (P < 0.01). HCC patients with PVT who underwent radioembolization achieved comparable survival to patients who received sorafenib, even after application of IPW. The radioembolization group also experienced fewer severe adverse effects. Radioembolization can be considered a new treatment option for patients with HCC with PVT.