Early identification of poor responders to transarterial chemoembolization for hepatocellular carcinoma
Early identification of poor responders to transarterial chemoembolization for hepatocellular carcinoma
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DOI：
10.1007/s12072-011-9276-9
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发表时间：
2011-12-01
影响因子：
6.6
通讯作者：
Lee, Shou-Dong
中科院分区：
文献类型：
--
作者：
Tsai, Ya-Ju;Hsu, Chia-Yang;Lee, Shou-Dong
目的肝动脉化疗栓塞术(TACE)用于治疗不能切除的肝细胞癌。然而，肝细胞癌患者TACE后的生存时间可能更短。对624例接受TACE治疗的肝癌患者和122例接受最佳支持治疗(BSC)的肝癌患者进行分析。不良反应者定义为经动脉化疗栓塞术后死亡或肿瘤存活(S)，但在治疗3个月后不再接受进一步治疗的患者。与接受TACE的其他患者相比，反应差的患者的长期存活率显著降低，而与接受骨髓干细胞治疗的患者相比，死亡风险更高(p<；0.001和p=0.054)。24个月存活率的比较显示，反应差的患者结果明显比接受BSC的患者差(p=0.04)。多因素Logistic回归分析显示，甲胎蛋白40 ng/mL(p=0.024)、白蛋白3.8g/dL(p=0.016)、B级(p=0.011)、功能状态1(p<；0.001)、肿瘤总体积65 cm(3)(p=0.001)、血管侵犯(p=0.005)是预测3个月疗效差的独立危险因素。在四种肝细胞癌分期系统中，巴塞罗那临床肝癌(BCLC)分级对不良反应者的预测准确率最高。结论不良反应者因TACE后疾病进展迅速而增加死亡风险。晚期BCLC可能更好地预测TACE的不良反应。
Purpose Transarterial chemoembolization (TACE) is used to treat unresectable hepatocellular carcinoma (HCC). However, HCC patients may have an even shorter survival after TACE. This study aimed to identify poor responders to TACE at an early stage.Patients and methods A total of 624 and 122 patients with HCC undergoing TACE and best supportive care (BSC), respectively, were analyzed. Poor responders were defined as patients who died after TACE or had viable tumor(s), but not eligible for further treatment at 3 months of treatment.Results A total of 102 (16%) patients were identified as poor responders. Poor responders had a significantly decreased long-term survival than other patients receiving TACE and a tendency of higher risk of mortality than patients receiving BSC (p < 0.001 and p = 0.054, respectively). The comparison of 24-month survival showed significantly worse outcome in poor responders than patients receiving BSC (p = 0.04). Serum alpha-fetoprotein (AFP) level > 40 ng/mL (p = 0.024) and albumin level 3.8 g/dL (p = 0.016), Child-Turcotte-Pugh (CTP) class B (p = 0.011), performance status 1 (p < 0.001), total tumor volume (TTV) > 65 cm(3) (p = 0.001), and vascular invasion (p = 0.005) were independent risk factors predicting poor response at 3 months in the multivariate logistic regression analysis. Among the four HCC staging systems, the Barcelona Clinic Liver Cancer (BCLC) classification showed the highest predictive accuracy for the identification of poor responders.Conclusions Poor responders have an increased risk of mortality due to rapid disease progression after TACE. Advanced BCLC stages may better predict a poor response to TACE.