Evaluation of responses to chemoembolization in patients with unresectable hepatocellular carcinoma
Evaluation of responses to chemoembolization in patients with unresectable hepatocellular carcinoma
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DOI：
10.1002/cncr.11111
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发表时间：
2003-02-15
期刊：
影响因子：
6.2
通讯作者：
Zajko, A
中科院分区：
文献类型：
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作者：
Ebied, OM;Federle, MP;Zajko, A
背景作者使用计算机断层扫描（CT）扫描将晚期不可切除的肝细胞癌（HCC）患者经导管动脉化疗栓塞（TACE）后肿瘤血管分布、坏死和大小的变化与疗效和生存率相关联。作者研究了72例经活检证实的不可切除的HCC患者，重点关注186个个体肿瘤肿块。进行了基线、多期、螺旋CT检查，并在TACE治疗后进行了至少3次随访CT扫描。根据肿瘤大小改变、肿瘤坏死和新肿瘤出现的CT证据，将肿瘤分类为多血管或少血管，将患者分类为应答者或无应答者。使用新的评分系统监测患者对TACE的反应。38例患者为应答者，34例为无应答者。多血管反应者的患者生存率显著增加（P = 0.009）。多血供无应答者的生存率也高于少血供无应答者（P = 0.008），少血供应答者的生存率高于少血供无应答者（P = 0.002）。对化疗栓塞的反应与肿瘤大小成反比（P = 0.02），但个体患者的肿瘤病灶数量不能预测。TALE似乎可以提高对治疗有反应的多血管肿瘤HCC患者的生存率。然而，即使被CT分类为多血管无反应者和低血管反应者的患者也提高了生存率。
BACKGROUND. The authors used computed tomography (CT) scans to correlate the changes in tumor vascularity, necrosis, and size with response and survival after transcatheter arterial chemoembolization (TACE) in patients with advanced, unresectable, hepatocellular carcinoma (HCC).METHODS. The authors studied 72 patients with biopsy-proven, unresectable HCC and focused on 186 individual tumor masses. A baseline, multiphase, helical CT was performed and at least three follow-up CT scans were performed after treatment by TACE. Tumors were classified as hypervascular or hypovascular and patients were classified as responders or nonresponders based on CT evidence of altered tumor size, tumor necrosis, and the appearance of new tumors. A new scoring system was used to monitor patient response to TACE.RESULTS. Thirty-eight patients were responders and 34 were nonresponders. Patient survival was significantly increased (P = 0.009) in patients who were hypervascular responders. Survival also was increased in hypervascular nonresponders compared with hypovascular nonresponders (P = 0.008) and in hypovascular responders compared with hypovascular nonresponders (P = 0.002). Response to chemoembolization was found to be significantly (P = 0.02) and inversely proportional to tumor size, but the number of tumor foci in an individual patient was not predictive.CONCLUSIONS. TALE appears to result in improved survival among HCC patients with hypervascular tumors who responded to therapy. However, even patients classified by CT as hypervascular nonresponders and hypovascular responders have improved survival.