Chemoembolization endpoints: effect on survival among patients with hepatocellular carcinoma.
Chemoembolization endpoints: effect on survival among patients with hepatocellular carcinoma.
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DOI：
10.2214/ajr.10.4770
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发表时间：
2011-04
期刊：
影响因子：
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通讯作者：
Omary RA
中科院分区：
文献类型：
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作者：
Jin B;Wang D;Lewandowski RJ;Riaz A;Ryu RK;Sato KT;Larson AC;Salem R;Omary RA
探讨肝细胞癌（HCC）患者经动脉化疗栓塞（TACE）的血管造影栓塞终点与生存率的关系。本研究回顾性评估了105例接受TACE的手术不可切除HCC患者。根据先前建立的主观血管造影化疗栓塞终点（SACE）量表对患者进行分类。只有1例患者被归类为SACE 1级，因此从所有后续分析中排除。采用Kaplan-Meier分析评价生存率。采用考克斯比例风险回归模型进行多因素分析，以确定生存的独立预后危险因素。总体中位生存期为21.1个月（95%置信区间[CI]，15.9-26.4）。栓塞至SACE 2级和3级的患者的中位生存期（25.6个月; 95% CI，16.2-35.0）显著高于栓塞至SACE 4级的患者（17.1个月; 95% CI，13.3-20.9）（p = 0.035）。多因素分析显示，SACE 4级（风险比[HR]，2.49; 95% CI，1.41-4.42; p = 0.002），欧洲肿瘤协作组体能状态> 0（HR，1.97; 95% CI，1.15-3.37; p = 0.013），美国癌症联合委员会3期或4期（HR，2.42; 95% CI，1.27-4.60; p = 0.007）和Child-Pugh分级B（HR，1.94; 95% CI，1.09-3.46; p = 0.025）均为独立的生存期阴性预后指标。与栓塞至较高的停滞终点（SACE 4级）相比，TACE期间栓塞至中等、亚停滞终点（SACE 2级和3级）可提高生存率。介入肿瘤学家应考虑在TACE期间瞄准这些中期、亚停滞血管造影终点。
To investigate the relationship between angiographic embolic endpoints of transarterial chemoembolization (TACE) and survival in patients with hepatocellular carcinoma (HCC). This study retrospectively assessed 105 patients with surgically unresectable HCC who underwent TACE. Patients were classified according to a previously established subjective angiographic chemoembolization endpoint (SACE) scale. Only one patient was classified as SACE level 1 and thus excluded from all subsequent analysis. Survival was evaluated with Kaplan-Meier analysis. Multivariate analysis with Cox’s proportional hazard regression model was used to determine independent prognostic risk factors of survival. Overall median survival was 21.1 months (95% confidence interval [CI], 15.9–26.4). Patients embolized to SACE levels 2 and 3 were aggregated and had a significantly higher median survival (25.6 months; 95% CI, 16.2–35.0) than patients embolized to SACE level 4 (17.1 months; 95% CI, 13.3–20.9) (p = 0.035). Multivariate analysis indicated that SACE level 4 (Hazard ratio [HR], 2.49; 95% CI, 1.41–4.42; p = 0.002), European Cooperative Oncology Group performance status > 0 (HR, 1.97; 95% CI, 1.15–3.37; p = 0.013), American Joint Committee on Cancer stage 3 or 4 (HR, 2.42; 95% CI, 1.27–4.60; p = 0.007), and Child-Pugh class B (HR, 1.94; 95% CI, 1.09–3.46; p = 0.025) were all independent negative prognostic indicators of survival. Embolization to an intermediate, sub-stasis endpoint (SACE levels 2 and 3) during TACE improves survival compared to embolization to a higher, stasis endpoint (SACE level 4). Interventional oncologists should consider targeting these intermediate, sub-stasis angiographic endpoints during TACE.