Transarterial Chemoembolization related to Good Survival for Selected Patients with advanced Hepatocellular Carcinoma
Transarterial Chemoembolization related to Good Survival for Selected Patients with advanced Hepatocellular Carcinoma
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经动脉化疗栓塞与部分晚期肝细胞癌患者的良好生存相关
DOI：
10.7150/jca.28528
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发表时间：
2019-01-01
影响因子：
3.9
通讯作者：
Shi, Ming
中科院分区：
文献类型：
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作者：
Le, Yong;Shen, Jing-Xian;Shi, Ming
背景和目标：晚期肝癌患者是否能从经动脉化疗栓塞（TACE）治疗中获益仍存在争议。本研究的目的是确定晚期HCC患者TACE后生存率的预测因素。研究方法：总体而言，本研究审查并入组了303例2009年1月至2013年12月期间首次接受中山大学癌症中心TACE治疗的巴塞罗那临床肝癌（BCLC）C期HCC患者。我们对预后因素进行了Kaplan-Meier和考克斯比例风险模型分析。结果：全组中位生存期为8.4个月。多变量考克斯回归分析证实，四个危险因素，高水平的γ-谷氨酰转肽酶（GGT），C-反应蛋白（CRP），碱性磷酸酶（ALP）和门静脉肿瘤血栓形成（PVTT）的存在，是总生存期的独立预后因素。具有0-1和2-4个风险因素的患者的预期中位生存期分别为18.1（95% CI：15.5-20.7）和6.8（95% CI：5.8-7.8）个月。在具有0-1和2-4个危险因素的患者中，客观肿瘤缓解率分别为38.9%和17.3%。结论：我们发现四个危险因素与晚期肝癌患者的总体生存率相关：血清GGT水平，血清CRP，血清ALP和PVTT的存在。对于具有0-1个危险因素的晚期HCC患者，由于预后良好，可推荐TACE。
Background & aims: It remains controversial whether patients with advanced-stage hepatocellular carcinoma could be benefit from transarterial chemoembolization (TACE) treatment. The purpose of the present study is to identify predictors of survival following TACE in patients with advanced HCC. Methods: Overall, 303 patients with Barcelona Clinic Liver Cancer (BCLC) stage C HCC who were first treated with TACE from Sun Yat-sen University Cancer Centre between January 2009 and December 2013 were reviewed and enrolled in this study. We carried out Kaplan-Meier and Cox proportional hazard model analyses of prognostic factors. Results: The median survival of the whole cohort was 8.4 months. Multivariable Cox regression analyses confirmed that four risk factors, high serum levels of gamma-glutamyl transpeptidase (GGT), C-reactive protein (CRP), alkaline phosphatase (ALP) and presence of portal vein tumour thrombosis (PVTT), were independent prognostic factors for overall survival. The expected median survival among patients with 0-1 and 2-4 risk factors were 18.1 (95% CI: 15.5-20.7) and 6.8 (95% CI: 5.8-7.8) months, respectively. Objective tumor response among patients with 0-1 and 2-4 risk factors were 38.9% and 17.3%, respectively. Conclusion: We found four risk factors were associated with dismal overall survival for advanced HCC patients: serum GGT level, serum CRP, serum ALP and presence of PVTT. TACE may be recommended for patients with advanced HCC with 0-1 risk factors due to the favourable prognosis.