Lack of response after initial chemoembolization for hepatocellular carcinoma: does it predict failure of subsequent treatment?
Lack of response after initial chemoembolization for hepatocellular carcinoma: does it predict failure of subsequent treatment?
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DOI：
10.1148/radiol.12112264
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发表时间：
2012-10
期刊：
影响因子：
19.7
通讯作者：
Frangakis C
中科院分区：
文献类型：
--
作者：
Georgiades C;Geschwind JF;Harrison N;Hines-Peralta A;Liapi E;Hong K;Wu Z;Kamel I;Frangakis C
（a）评估肝细胞癌（HCC）在初次无反应后对化疗栓塞的反应，初次无反应依据欧洲肝脏研究协会（EASL）标准和改良的实体瘤反应评估标准（mRECIST）判定；（b）比较初次无反应者与初次有反应者治疗后的生存率。
机构审查委员会批准了这项符合《健康保险流通与责任法案》（HIPAA）的回顾性研究。共纳入116例连续的不可切除肝细胞癌患者（96例男性，20例女性；平均年龄63岁），这些患者均接受了至少两次化疗栓塞治疗。化疗栓塞混合剂由100mg顺铂、50mg阿霉素和10mg丝裂霉素C与碘化油按1∶1混合而成。每次化疗栓塞治疗后，依据EASL标准和mRECIST在磁共振成像上评估肿瘤反应。计算各亚组的生存率并与反应相关联。采用威尔科克森检验来检验组间的可比性。采用卡普兰 - 迈耶估计量生成生存曲线，并使用对数秩检验进行比较。
依据EASL标准和mRECIST，分别有43%和50%的患者对初次化疗栓塞无反应。在第二次化疗栓塞治疗后，初次无反应者中有44%（依据EASL标准）和47%（依据mRECIST）显示出明显反应。依据EASL标准，两次化疗栓塞治疗后，无反应者1年、2年和3年生存率（±平均标准误差）分别为39%±10、14%±7和0%，有反应者分别为68%±10、50%±11和37%±11（1年、2年和3年时P = 0.036、P = 0.006和P < 0.005）。依据mRECIST，两次化疗栓塞治疗后，无反应者1年、2年和3年生存率分别为49%±9、20%±8和7%±6，有反应者分别为67%±9、44%±10和36%±9（1年、2年和3年时P = 0.174、P = 0.046和P = 0.011）。
接受肝细胞癌化疗栓塞治疗的患者在第二次化疗栓塞治疗后显示出反应（依据EASL标准和mRECIST）且生存率提高。在放弃进一步治疗之前，应对相同的靶病灶至少进行两次化疗栓塞治疗。
To (a) evaluate the response of hepatocellular carcinoma (HCC) to chemoembolization after initial nonresponse, as determined with European Association for the Study of the Liver (EASL) criteria and modified Response Evaluation Criteria in Solid Tumors (mRECIST), and (b) compare posttreatment survival of initial nonresponders versus that of initial responders. The institutional review board approved this retrospective study, which was compliant with HIPAA. A total of 116 consecutive patients (96 men, 20 women; mean age, 63 years) with unresectable HCC who underwent at least two chemoembolization procedures were included. The chemoembolization mixture consisted of 100 mg of cisplatin, 50 mg of doxorubicin, and 10 mg of mitomycin C mixed 1:1 with iodized oil. Tumor response at magnetic resonance imaging was evaluated after each chemoembolization procedure according to EASL criteria and mRECIST. The survival rate in each subgroup was calculated and correlated with response. The Wilcoxon test was used to test group comparability. Kaplan-Meier estimators were used to generate survival curves and compared by using the log-rank test. No response to initial chemoembolization was seen in 43% and 50% of patients according to EASL criteria and mRECIST, respectively. After a second chemoembolization procedure, 44% (EASL) and 47% (mRECIST) of initial nonresponders showed a significant response. With EASL criteria, the 1-, 2-, and 3-year survival rates (±standard error of the mean) after two chemoembolization procedures were 39% ± 10, 14% ± 7, and 0%, respectively, for non-responders and 68% ± 10, 50% ± 11, and 37% ± 11 for responders (P = .036, P = .006, and P < .005 at 1, 2, and 3 years). With mRECIST, the 1-, 2-, and 3-year survival rates after two chemoembolization procedures were 49% ± 9, 20% ± 8, and 7% ± 6 for nonresponders and 67% ± 9, 44% ± 10, and 36% ± 9 for responders (P = .174, P = .046, and P = .011 at 1, 2, and 3 years). Patients who underwent chemoembolization for HCC showed a response (with both EASL criteria and mRECIST) and improved survival after the second chemoembolization treatment. At least two chemoembolization procedures should be performed in the same targeted lesions before further treatment is abandoned.
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