Influence of pretreatment tumor growth rate on objective response of hepatocellular carcinoma treated with transarterial chemoembolization
Influence of pretreatment tumor growth rate on objective response of hepatocellular carcinoma treated with transarterial chemoembolization
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DOI：
10.1111/jgh.14816
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发表时间：
2019-08-20
影响因子：
4.1
通讯作者：
Ronot, Maxime
中科院分区：
文献类型：
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作者：
Purcell, Yvonne;Sartoris, Riccardo;Ronot, Maxime
背景与目的本研究旨在评估预处理肿瘤生长速率（TGR）对实体瘤改良反应评价标准（mRECIST）的影响，以及肝癌（HCC）第一次选择性经动脉化疗栓塞（TACE）治疗后客观反应（OR）的影响。方法纳入115例患者（101例男性[88%]，平均65.1 +/- 10.5岁[范围26-87]），169个肿瘤（平均34.2 +/- 29.3 mm[10-160]），于2011年至2016年接受第一次选择性TACE治疗HCC。TGR计算为治疗前影像学每月肿瘤体积变化百分比（%/月）。通过受试者工作特征曲线分析，确定预测OR的TGR截止值。结果术后1个月ct显示，88/189（52%）和46/189（27%）肿瘤完全缓解（CR）和部分缓解（PR） （OR率79%），32/189（19%）肿瘤病情稳定（SD）， 3/189（2%）肿瘤病情进展（PD）。平均预处理TGR为12.0 +/- 15.4(-3.2-90.4)%/月。CR、PR、SD、PD肿瘤的TGR平均值分别为13.2 +/- 16.4%、12.1 +/- 15.1%、5.3 +/- 4.5%、44.8 +/- 20.4% （P < 0.001）。3例显示PD的肿瘤TGR值为10 ~ 20%/月。合并OR的肿瘤中TGR显著升高（12.8 +/- 15.9% vs 5.3 +/- 4.5%, P = 0.009）。截断值为6.5%/月的OR预测值最高（AUROC为0.65 +/- 0.05,P = 0.009）。结论肝癌TACE前TGR具有较高的变异性，预测肿瘤反应呈u型分布。它提供了对肿瘤生物学的深入了解，可以在预处理工作中使用，以帮助患者分层。
Background and Aim The study aims to assess the influence of pretreatment tumor growth rate (TGR) on modified response evaluation criteria in solid tumors (mRECIST) objective response (OR) after a first session of selective transarterial chemoembolization (TACE) for the treatment of hepatocellular carcinoma (HCC). Methods One hundred fifteen patients (101 men [88%], mean 65.1 +/- 10.5 years [range 26-87]) with 169 tumors (mean 34.2 +/- 29.3 mm [10-160]), undergoing a first session of selective TACE for the treatment of HCC between 2011 and 2016, were included. TGR was calculated as the percentage change in tumor volume per month (%/month) on imaging before treatment. TGR cut-off for prediction of OR was identified by receiver operating characteristic curve analysis. Results Overall 88/189 (52%) and 46/189 (27%) tumors showed complete response (CR) and partial response (PR) (OR rate 79%), while 32/189 (19%) showed stable disease (SD), and 3/189 (2%) were progressive disease (PD) on computed tomography at 1-month post-TACE. The mean pretreatment TGR was 12.0 +/- 15.4 (-3.2-90.4) %/month. TGR of tumors showing CR, PR, SD, and PD was a mean 13.2 +/- 16.4%, 12.1 +/- 15.1%, 5.3 +/- 4.5%, and 44.8 +/- 20.4%, respectively (P < 0.001). The three tumors showing PD had TGR values > 20%/month. TGR was significantly higher in tumors with OR (12.8 +/- 15.9% vs 5.3 +/- 4.5% in SD, P = 0.009). A cut-off value of 6.5%/month had the highest predictive value of OR (AUROC 0.65 +/- 0.05, P = 0.009). Conclusion Pretreatment TGR is highly variable in HCC before TACE with a U-shaped distribution for the prediction of tumor response. It provides insight into tumor biology that may be used during pretreatment workup to help stratify patients.