Yttrium-90 radioembolization treatment for unresectable hepatocellular carcinoma: a single-centre prognostic factors analysis
Yttrium-90 radioembolization treatment for unresectable hepatocellular carcinoma: a single-centre prognostic factors analysis
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DOI：
10.1007/s12032-017-1021-3
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发表时间：
2017-10-01
期刊：
影响因子：
3.4
通讯作者：
Carrafiello, G.
中科院分区：
文献类型：
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作者：
Floridi, C.;Pesapane, F.;Carrafiello, G.
本研究的目的是评估 Y90 放射栓塞 (Y90-RE) 对不可切除的肝细胞癌 (HCC) 患者的疗效和安全性，分析我们的结果并将其与总生存期 (OS) 和并发症的独立预后因素相关联。对 43 名晚期不能手术的 HCC 患者进行了回顾，其中包括接受 Y90-RE 治疗的多发性双叶病变或门静脉血栓 (PVT) 患者。评估治疗效果和安全性。通过Kaplan-Meier法计算存活率。进行单变量分析以确定潜在的预后因素。放射学反应采用修改后的实体瘤反应评估标准 (mRECIST) 标准进行评估。前瞻性记录临床毒性。中位总无进展生存期和 OS 分别为 27.7 个月和 16.8 个月。没有 PVT 的患者 (p = 0.0241) 和治疗前血红蛋白值较高的患者 (p = 0.0471) 的中位 OS 较长。根据 mRECIST 标准，我们观察到 3 个月和 6 个月随访时的疾病控制率分别为 69.2% 和 61.9%。 28 名患者（65.1%）出现并发症，其中 17 名患者报告了 2-3 级事件。我们注意到，活动给药剂量与术中毒性相关（p = 0.039259），而使用肝总动脉作为释放部位与最常见的远程不良事件相关。 Y90-RE 是一种替代疗法，对于低风险晚期不能手术的 HCC 具有良好的疗效。 PVT 和治疗前血红蛋白值可以作为疗效的预测指标。活动给药剂量和动脉释放部位可以作为安全性的预测因素。
The aim of this study was to evaluate the efficacy and the safety of Y90 radioembolization (Y90-RE) in patients with unresectable hepatocellular carcinoma (HCC) analysing our results and correlating them with independent prognostic factors for overall survival (OS) and for complications. Forty-three patients with advanced inoperable HCC including those with multiple bilobar lesions or portal vein thrombosis (PVT) treated with Y90-RE were reviewed. Treatment efficacy and safety were evaluated. Survival was calculated by the Kaplan-Meier method. Univariate analyses were performed for identifying potential prognostic factors. Radiologic response was evaluated with the modified Response Evaluation Criteria in Solid Tumours (mRECIST) criteria. Clinical toxicities were prospectively recorded. Median overall progressionfree survival and OS were 27.7 and 16.8 months, respectively. Longer median OS was revealed in those without PVT (p = 0.0241) and those whose pre-treatment haemoglobin values was higher (p = 0.0471). According with mRECIST criteria, we observed a disease control rate of 69.2 and 61.9% at 3-and 6-month follow-up, respectively. Complications developed in 28 patients (65.1%), among which grade 2-3 events were reported in 17 patients. We noted that activity administered dose presented a correlation with intra-procedural toxicity (p = 0.039259) while common hepatic artery use as release site was associated with a most frequent presentation of remote adverse events. Y90-RE is an alternative treatment with a promising outcome for poor-risk advanced inoperable HCC. PVT and pre-treatment haemoglobin values can be predictors of efficacy. Activity administered dose and arterial release site can be predictors of safety.