Transcatheter arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC): The role of angiogenesis and invasiveness
Transcatheter arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC): The role of angiogenesis and invasiveness
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DOI：
10.1111/j.1572-0241.2007.01712.x
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发表时间：
2008-04-01
影响因子：
9.8
通讯作者：
Farinati, Fabio
中科院分区：
文献类型：
--
作者：
Sergio, Adriana;Cristofori, Chiara;Farinati, Fabio
目的：虽然经导管动脉化疗栓塞术（TACE）在肝细胞癌（HCC）中是有效的，但它并不被认为是一种治愈性手术。在可能干扰其有效性的因素中，有一种假设的缺血引起的新生血管反应。在我们的研究中，我们评估了两种血管生成因子水平的变化，（血管内皮生长因子[VEGF]和碱性成纤维细胞生长因子[b-FGF]）和一个侵袭性参数方法：从71名接受TACE治疗的HCC患者中提供三份血液样本：TACE前（t0）、术后3天（t1）、术后4 wk行螺旋CT扫描（t2）。转诊放射科医生在t0时盲法评价肿瘤负荷和血管形成，在t2时评价残留活性。肝动脉化疗栓塞治疗的选择是基于美国肝脏疾病研究协会（AASLD）guidelines.Results：27%的患者在sCT时完全缓解，平均生存期为35个月（置信区间[CI] 31-40），4年生存率为57%。VEGF水平与淋巴结数量显著相关，并且在t2时无应答者中更高（P = 0.01）;低于中位数的VEGF水平预示着更长的生存期（P = 0.008）。b-FGF与VEGF、肿瘤大小、血管形成和残余活性相关，显示与生存的边缘相关性。uPA与肿瘤大小、VEGF相关。VEGF被挑出来的考克斯多变量分析作为一个独立的预测survival.CONCLUSIONS：当TACE是不完全有效的，它可能会引起显着的新生血管生成反应，建议增加VEGF和b-FGF治疗后，这会影响患者的生存。VEGF是最可靠的预后指标，可作为判断TACE疗效的指标。最后，抗血管生成药物可能适用于TACE治疗的HCC。
OBJECTIVE: Although transcatheter arterial chemoembolization (TACE) is effective in hepatocellular carcinoma (HCC), it is not considered a curative procedure. Among the factors potentially interfering with its effectiveness is a hypothetical neoangiogenic reaction due to ischemia. In our study, we evaluated the changes in the levels of two angiogenic factors (vascular endothelial growth factor [VEGF] and basic fibroblast growth factor [b-FGF]) and one parameter of invasiveness (urokinase-type plasminogen activator [uPA]) in patients treated with TACE.METHODS: Three blood samples were provided from 71 HCC patients undergoing TACE: before TACE (t0), after 3 days (t1), and after 4 wk, when they had spiral computed tomography (sCT) scanning (t2). The referring radiologists blindly evaluated tumor burden and vascularization at t0 and residual activity at t2. The choice of TACE as treatment was based on the American Association for the Study of Liver Diseases (AASLD) guidelines.RESULTS: Complete response at sCT was recorded in 27% of patients; mean survival was 35 months (confidence interval [CI] 31-40) and the 4-yr survival was 57%. VEGF levels were significantly correlated with the number of nodes and were higher in nonresponders at t2 (P = 0.01); below-median VEGF levels predicted a longer survival (P = 0.008). b-FGF correlated with VEGF, tumor size, vascularization, and residual activity, showing a borderline correlation with survival. uPA correlated with tumor size and VEGF. VEGF was singled out in the Cox multivariate analysis as an independent predictor of survival.CONCLUSIONS: When TACE is not totally effective, it may induce a significant neoangiogenetic reaction, as suggested by an increase in VEGF and b-FGF following treatment; this affects patient survival. VEGF emerges as the most reliable prognostic parameter, so it could be measured for judging TACE efficacy. Finally, antiangiogenic drugs may be indicated in TACE-treated HCC.