Microvascular Invasion as a Predictor of Response to Treatment with Sorafenib and Transarterial Chemoembolization for Recurrent Intermediate-Stage Hepatocellular Carcinoma
Microvascular Invasion as a Predictor of Response to Treatment with Sorafenib and Transarterial Chemoembolization for Recurrent Intermediate-Stage Hepatocellular Carcinoma
复制标题
微血管侵袭作为索拉非尼和经动脉化疗栓塞治疗复发性中期肝细胞癌疗效的预测因子
DOI：
10.1148/radiol.2019181818
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发表时间：
2019-07-01
期刊：
影响因子：
19.7
通讯作者：
Kuang, Ming
中科院分区：
文献类型：
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作者：
Peng, Zhenwei;Chen, Shuling;Kuang, Ming
背景资料：索拉非尼联合经动脉化疗栓塞（TACE）治疗中期复发性肝细胞癌（HCC）的证据有限。由于中期复发性HCC的异质性，患者对这种治疗的反应各不相同，因此确定最有可能从这种联合治疗中获益的患者非常重要。目的：比较索拉非尼联合TACE与单独TACE治疗初次肝切除术后复发的中期HCC，并确定微血管浸润（MVI）的关系材料和方法：在这项回顾性多中心研究中，从2010年1月至2016年12月，发现3652例原发性肝癌初次肝切除术后肝内复发的连续患者。其中，260例中期复发HCC患者接受索拉非尼联合TACE或单纯TACE治疗。采用log-rank检验比较两组患者的总生存期（OS）和无进展生存期（PFS）（平均年龄，55岁+/- 7.6 [标准差]; 107名男性）和132名患者单独接受TACE治疗（平均年龄，56岁+/- 8.3; 110名男性）。联合治疗组的5年OS和PFS高于TACE组（OS：分别为38.9%和20.5%，P = 0.01; PFS：分别为37.5%和18.7%，P = 0.003）。对于MV I阳性病变患者，联合治疗后的中位OS和PFS（n = 55）长于TACE单独治疗后的中位OS和PFS（n = 72; OS：分别为17.2个月vs 12.1个月，P = 0.02; PFS：分别为17.0个月vs 11.0个月，P = 0.02）。多因素分析显示肿瘤数目、MVI状态和治疗分配是OS和PFS的显著预测因素，而肿瘤大小是PFS的预后因素。结论：复发性中期肝癌和微血管浸润（MVI）阳性的患者使用索拉非尼联合经动脉化疗栓塞（TACE）治疗比单独TACE治疗的生存时间更长;合并治疗对MVI阴性病变患者的生存率无明显影响。(C)RSNA，2019年。
Background: The evidence of combining sorafenib with transarterial chemoembolization (TACE) for intermediate-stage recurrent hepatocellular carcinoma (HCC) is limited. Patient responses to this treatment varied because of the heterogeneous nature of intermediate-stage recurrent HCC, making it important to identify patients who are most likely to benefit from this combination therapy.Purpose: To compare sorafenib administered in combination with TACE versus TACE alone in the treatment of recurrent intermediate-stage HCC after initial hepatectomy and to determine the relationship of microvascular invasion (MVI) to survival.Materials and Methods: In this retrospective multicenter study, 3652 consecutive patients were found to have intrahepatic recurrences after initial hepatectomy of primary HCC from January 2010 to December 2016. Of these, 260 patients with intermediatestage recurrent HCC underwent combination treatment with sorafenib and TACE or TACE alone. Overall survival (OS) and progression-free survival (PFS) were compared between these two treatments according to MVI status by using log-rank tests.Results: A total of 128 patients were administered combination therapy (mean age, 55 years +/- 7.6 [standard deviation]; 107 men) and 132 patients were administered TACE alone (mean age, 56 years +/- 8.3; 110 men). The 5-year OS and PFS were higher in the combination group than in the TACE group (OS: 38.9% vs 20.5%, respectively, P =.01; PFS, 37.5% vs 18.7%, respectively, P =.003). For patients with MVI-positive lesions, the median OS and PFS after combination treatment (n = 55) were longer than those after TACE alone (n = 72; OS: 17.2 months vs 12.1 months, respectively, P =.02; PFS: 17.0 months vs 11.0 months, respectively, P = .02). Multivariable analysis showed that tumor number, MVI status, and treatment allocation were significant predictors of OS and PFS, whereas tumor size was a prognostic factor for PFS.Conclusion: Patients with recurrent intermediate-stage hepatocellular carcinoma and lesions positive for microvascular invasion (MVI) had longer survival times by using a combined treatment of sorafenib with transarterial chemoembolization (TACE) compared with TACE alone; patients with MVI-negative lesions did not show survival benefit from combined therapy. (C) RSNA, 2019.