Complete response at first chemoembolization is still the most robust predictor for favorable outcome in hepatocellular carcinoma
Complete response at first chemoembolization is still the most robust predictor for favorable outcome in hepatocellular carcinoma
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DOI：
10.1016/j.jhep.2015.01.022
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发表时间：
2015-06-01
影响因子：
25.7
通讯作者：
Han, Kwang-Hyub
中科院分区：
文献类型：
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作者：
Kim, Beom Kyung;Kim, Seung Up;Han, Kwang-Hyub
背景和目标：本研究的目的是评估的预后意义，不仅在反复肝细胞癌（HCC）的肝动脉化疗栓塞术（TACE）的初始和最佳反应，但如果符合条件，也达到治疗respons.Methods的时间点：三百十四个治疗初治患者肝功能保存完好，接受TACE。使用改良的实体瘤疗效评价标准评估治疗疗效。采用Kaplan-Meier法分析总生存期（OS），多因素分析采用考克斯回归分析。在调整其他变量后，（完全缓解[CR]和部分缓解[PR]）作为初始缓解（校正风险比[HR] 0.410）和最佳缓解（校正HR 0.335）分别对OS具有独立的预后意义（均p < 0.001）。作为初始应答的客观应答者的OS最长，其次是在至少两个疗程后随后达到客观应答的患者和最终在治疗过程中未达到客观应答的患者（分别为52.6、27.0和10.8个月;对数秩检验，p < 0.001）。同样，初始缓解为CR的患者的OS最长，其次是至少两次治疗后达到CR的患者和最佳缓解为PR的患者（分别为70.2、40.6和23.0个月;对数秩检验，p < 0.001）。大肿瘤（>5 cm）和多发肿瘤（>= P4）与初次TACE后CR失败独立相关（均p < 0.05）。结论：初次和最佳缓解均可有效预测OS。然而，在早期时间点实现治疗反应仍然是有利结果的最有力预测因素。(C)2015年欧洲肝脏研究协会。Elsevier B. V.出版，保留所有权利。
Backgrounds & Aims: The aim of this study is to evaluate the prognostic significances of not only the initial and the best response during repeated transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC), but if eligible, also the time point of achieving treatment responses.Methods: Three hundred and fourteen treatment-naive patients with well-preserved liver function undergoing TACE were recruited. Treatment responses were assessed using modified Response Evaluation Criteria in Solid Tumors. Overall survival (OS) was analyzed using Kaplan-Meier methods, and Cox regression analysis was performed for multivariate analysis.Results: After adjusting other variables, objective response (complete response [CR] and partial response [PR]) as the initial response (adjusted hazard ratio [HR] 0.410) and the best response (adjusted HR 0.335) had independent prognostic significances for OS, respectively (both p < 0.001). Objective responders as the initial response had the longest OS, followed by patients who subsequently achieved objective response after at least two sessions and those who did not achieve objective response during treatment course eventually (52.6, 27.0, and 10.8 months, respectively; log-rank test, p < 0.001). Likewise, patients with CR as the initial response had the longest OS, followed by those who subsequently achieved CR after at least two sessions and those who achieved PR as the best response (70.2, 40.6, and 23.0 months, respectively; log-rank test, p < 0.001). Large (>5 cm) and multiple (>= P4) tumors were independently associated with failure to achieve CR after the initial TACE (both p < 0.05).Conclusion: Both the initial and the best response predicts OS effectively. However, achievement of treatment response at an early time point is still the most robust predictor for favorable outcomes. (C) 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.