Prognostic prediction across a gradient of total tumor volume in patients with hepatocellular carcinoma undergoing locoregional therapy.
Prognostic prediction across a gradient of total tumor volume in patients with hepatocellular carcinoma undergoing locoregional therapy.
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DOI：
10.1186/1471-230x-10-146
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发表时间：
2010-12-31
影响因子：
2.4
通讯作者：
Lee SD
中科院分区：
文献类型：
--
作者：
Huo TI;Hsu CY;Huang YH;Su CW;Lin HC;Lee RC;Chiou YY;Chiang JH;Lee PC;Lee SD
肿瘤的大小和数量是肝细胞癌（HCC）的重要预后指标。然而，很难评估肿瘤数量和大小不同的患者的预后。通过结合这两个因素，我们研究了肿瘤总体积 (TTV) 对 HCC 的作用和预后准确性。共有 786 名因 HCC 接受局部治疗（经动脉化疗栓塞、经皮射频消融和醋酸或乙醇注射）的患者进行了前瞻性评估。 TTV 的平均值和中位数分别为 177 cm3（范围：0.1-3,591 cm3）和 21 cm3。其中，38%、29%、15%、7% 和 11% 的患者 TTV 分别为 <10 cm3、10-50 cm3、50-200 cm3、200-500 cm3 和 >500 cm3。血清甲胎蛋白（AFP）水平较高或有血管侵犯的患者的 TTV 显着较大。 Child-Turcotte-Pugh 评分、体能状态、血管侵犯、AFP 水平和 TTV 是 Cox 比例风险模型中显着的独立预后预测因子。调整后，与 TTV <10 cm3 的患者相比，TTV 50-200 cm3（相对风险 [RR]：1.74，p = 0.009）、200-500 cm3（RR：2.15，p = 0.006）和 >500 cm3（RR：3.92，p < 0.001）患者的死亡风险显着增加。 TTV 是一种可行的宽梯度预后预测因子，可用于预测 HCC 的死亡风险。选择适当的 TTV 截止值可能有助于完善癌症分期系统和治疗计划的设计。未来的 HCC 临床试验可能包括此参数用于死亡风险分层。
The size and number of tumors are important prognostic indicators for hepatocellular carcinoma (HCC). However, it is difficult to assess the prognosis for patients with a variable number and size of tumors. By combining these two factors, we investigated the role and prognostic accuracy of total tumor volume (TTV) for HCC. A total of 786 patients undergoing locoregional therapy (transarterial chemoembolization, percutaneous radiofrequency ablation and acetic acid or ethanol injection) for HCC were prospectively evaluated. The mean and median TTV was 177 cm3 (range, 0.1-3,591 cm3) and 21 cm3, respectively. Of all, 38%, 29%, 15%, 7% and 11% of patients had TTV of <10 cm3, 10-50 cm3, 50-200 cm3, 200-500 cm3 and >500 cm3, respectively. TTV was significantly larger in patients with higher serum α-fetoprotein (AFP) levels or with vascular invasion. The Child-Turcotte-Pugh score, performance status, vascular invasion, AFP level and TTV were significant independent prognostic predictors in the Cox proportional hazards model. After adjustment, patients with TTV 50-200 cm3 (relative risk [RR]: 1.74, p = 0.009), 200-500 cm3 (RR: 2.15, p = 0.006) and >500 cm3 (RR: 3.92, p < 0.001) had a significantly increased mortality risk in comparison to patients with TTV <10 cm3. TTV is a feasible prognostic predictor across a wide gradient and can be used to predict the mortality risk of HCC. Selecting appropriate cutoffs of TTV may help refine the design of cancer staging system and treatment planning. Future clinical trials of HCC may include this parameter for mortality risk stratification.