Hypovascular hepatic nodules as a predictive factor for transcatheter arterial chemoembolization refractoriness in hepatocellular carcinoma
Hypovascular hepatic nodules as a predictive factor for transcatheter arterial chemoembolization refractoriness in hepatocellular carcinoma
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DOI：
10.1111/hepr.13446
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发表时间：
2019-12-01
影响因子：
4.2
通讯作者：
Takehara, Tetsuo
中科院分区：
文献类型：
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作者：
Maesaka, Kazuki;Sakamori, Ryotaro;Takehara, Tetsuo
目的经导管动脉化疗栓塞术（TACE）治疗的中期肝细胞癌（HCC）是一个高度异质性的人群，其TACE疗效的预测因素尚未确定。本研究旨在评估与中期HCC共存的少血供肝结节作为TACE难治性的重要预测因素的影响。方法回顾性分析66例首次行TACE治疗的中期肝癌患者的临床资料。在所有初始TACE之前，通过动态计算机断层扫描或磁共振成像以及血管造影检测到低血供肝结节。至TACE难治性时间（TTTR）定义为从首次TACE至诊断为TACE难治性的时间。结果36例（54.5%）肝内出现少血供结节，其中单发结节15例（41.7%），多发结节21例（58.3%），最大结节中位直径10 mm（5-80 mm）。所有患者的中位TTTR为17.4个月，伴和不伴少血供肝结节的患者分别为7.3和33.1个月。少血供肝结节的TTTR明显短于其他患者。在多变量分析中，存在少血供肝结节（HR 7.016，95% CI 3.534-13.930; P < 0.001）和超出7项标准（HR 2.861，95% CI 1.493-5.486; P = 0.002）是短TTTR的独立危险因素。结论：中期肝癌患者出现少血供肝结节是TACE治疗无效的一个重要预测因素。
Aim Intermediate-stage hepatocellular carcinoma (HCC) targeted for transcatheter arterial chemoembolization (TACE) corresponds to a highly heterogeneous population for whom the factors predicting TACE efficacy have not been established. This study aimed to evaluate the impact of hypovascular hepatic nodules coexisting with intermediate-stage HCC as a significant predictive factor for TACE refractoriness. Methods A total of 66 patients with intermediate-stage HCC who received initial TACE were retrospectively analyzed. Hypovascular hepatic nodules were detected by dynamic computed tomography or magnetic resonance imaging, as well as angiography, before all initial TACE. The time to TACE refractoriness (TTTR) was defined as the period from initial TACE until the diagnosis of TACE refractoriness. Results Hypovascular hepatic nodules were detected in 36 patients (54.5%), 15 (41.7%) of whom had a single nodule, whereas 21 (58.3%) had multiple nodules, and the median size of the maximum nodule was 10 mm (range 5-80 mm). The median TTTR was 17.4 months for all patients, and 7.3 and 33.1 months for patients with and without hypovascular hepatic nodules, respectively. The TTTR was significantly shorter for patients with hypovascular hepatic nodules than that for the other patients. In the multivariate analysis, the presence of hypovascular hepatic nodules (HR 7.016, 95% CI 3.534-13.930; P < 0.001) and being out of the up-to-seven criteria (HR 2.861, 95% CI 1.493-5.486; P = 0.002) were independent risk factors for a short TTTR. Conclusions The presence of hypovascular hepatic nodules with intermediate-stage HCC represents a significant predictive risk factor for TACE refractoriness.