Hepatocellular Carcinoma Demonstrates Heterogeneous Growth Patterns in a Multicenter Cohort of Patients With Cirrhosis
Hepatocellular Carcinoma Demonstrates Heterogeneous Growth Patterns in a Multicenter Cohort of Patients With Cirrhosis
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DOI：
10.1002/hep.31159
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发表时间：
2020-10-25
期刊：
影响因子：
13.5
通讯作者：
Singal, Amit G.
中科院分区：
文献类型：
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作者：
Rich, Nicole E.;John, Binu V.;Singal, Amit G.
背景和目的 尽管对监测、预后和治疗有影响，但关于肝细胞癌 (HCC) 生长模式的数据有限，特别是在西方队列中。我们研究的目的是量化肿瘤倍增时间 (TDT) 并确定与惰性和快速生长相关的相关性。方法和结果我们对 2008 年至 2017 年在美国和欧洲的六个卫生系统诊断为 HCC 的肝硬化患者进行了一项回顾性多中心队列研究，在 HCC 治疗前进行了两次或两次以上的对比增强成像研究，间隔≥ 30 天。放射科医生独立测量肿瘤的三个维度，以计算 TDT 和特定生长率 (SGR)。我们使用多变量序数逻辑回归来确定与惰性（TDT > 365 天）和快速（TDT < 90 天）肿瘤生长相关的因素。在主要队列中（n = 来自四个中心的 242 名患者），中位 TDT 为 229 天（四分位距 [IQR]，89-627），中位 SGR 为每天 0.3%（IQR，0.1%-0.8%）。超过三分之一 (38%) 的 HCC 呈惰性生长，36.8% 为中等生长，25.2% 为快速生长。在多变量分析中，惰性生长与较大的肿瘤直径（比值比 [OR]，1.15，95% 置信区间 [CI]，1.03-1.30）和甲胎蛋白 < 20 ng/mL（OR，1.90；95% CI，1.12-3.21）相关。惰性生长在非病毒性肝硬化中比病毒性肝硬化更常见（50.9% 对比 32.1%），特别是在 T1 HCC 患者中（OR，3.41；95% CI，1.08-10.80）。在一个独立队列（n = 来自两个中心的 176 名患者）中，中位 TDT（169 天；IQR 74-408 天）和 SGR（每天 0.4%）相似。 结论 在大型西方 HCC 患者队列中，我们发现异质性肿瘤生长模式，四分之一表现出快速生长，超过三分之一表现出惰性生长。更好地了解不同的肿瘤生长模式可能有助于采取精确的预测和治疗方法。
Background and Aims There are limited data on hepatocellular carcinoma (HCC) growth patterns, particularly in Western cohorts, despite implications for surveillance, prognosis, and treatment. Our study's aim was to quantify tumor doubling time (TDT) and identify correlates associated with indolent and rapid growth.Approach and Results We performed a retrospective multicenter cohort study of patients with cirrhosis diagnosed with HCC from 2008 to 2017 at six US and European health systems with two or more contrast-enhanced imaging studies performed >= 30 days apart prior to HCC treatment. Radiologists independently measured tumors in three dimensions to calculate TDT and specific growth rate (SGR). We used multivariable ordinal logistic regression to identify factors associated with indolent (TDT > 365 days) and rapid (TDT < 90 days) tumor growth. In the primary cohort (n = 242 patients from four centers), median TDT was 229 days (interquartile range [IQR], 89-627) and median SGR was 0.3% per day (IQR, 0.1%-0.8%). Over one-third (38%) of HCCs had indolent growth, 36.8% intermediate growth, and 25.2% rapid growth. In multivariable analysis, indolent growth was associated with larger tumor diameter (odds ratio [OR], 1.15, 95% confidence interval [CI], 1.03-1.30) and alpha-fetoprotein < 20 ng/mL (OR, 1.90; 95% CI, 1.12-3.21). Indolent growth was more common in nonviral than viral cirrhosis (50.9% versus 32.1%), particularly in patients with T1 HCC (OR, 3.41; 95% CI, 1.08-10.80). Median TDT (169 days; IQR 74-408 days) and SGR (0.4% per day) were similar in an independent cohort (n = 176 patients from two centers).Conclusions In a large Western cohort of patients with HCC, we found heterogeneous tumor growth patterns, with one-fourth exhibiting rapid growth and over one-third having indolent growth. Better understanding different tumor growth patterns may facilitate a precision approach to prognostication and treatment.