Hepatic Function during Repeated TACE Procedures and Prognosis after Introducing Sorafenib in Patients with Unresectable Hepatocellular Carcinoma: Multicenter Analysis
Hepatic Function during Repeated TACE Procedures and Prognosis after Introducing Sorafenib in Patients with Unresectable Hepatocellular Carcinoma: Multicenter Analysis
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DOI：
10.1159/000480256
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发表时间：
2017-01-01
影响因子：
2.3
通讯作者：
Michitaka, Kojiro
中科院分区：
文献类型：
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作者：
Hiraoka, Atsushi;Kumada, Takashi;Michitaka, Kojiro
背景/目的：我们评估了不同患者队列索拉非尼治疗后肝功能与重复经动脉导管化疗栓塞（TACE）和预后的关系。研究方法：研究1包括212例分类为Child-Pugh A（CP-A）并接受重复TACE治疗（r-TACE）的巴塞罗那诊所肝癌B期（BCLC-B）HCC患者（初治：复发= 66：146）。研究2包括435例不能切除的HCC患者，这些患者被分类为CP-A，并接受了索拉非尼治疗（初治：复发= 37：398; CP评分5：6 = 282：153;大血管浸润[MVI]+：肝外转移[EHM]+均为阴性= 124：226：143）。评价了研究1中r-TACE期间肝功能沿着CP和白蛋白胆红素（ALBI）评分/等级的变化，以及研究2中引入索拉非尼后的预后。结果：每次TACE手术后，9-14%的肝功能恶化至CP-B，而18-21%的分类从ALBI-1变为ALBI-2。当分析最佳CP评分为5的患者的预后时，ALBI-1组（n = 154）的预后优于ALBI-2组（n = 128）（MST 17.5 vs. 9.9个月; p = 0.01），而ALBI-1（n = 43）患者的结局也优于无MVI/EHM的CP评分为5的ALBI-2（n = 34）患者（MST：17.5与10.0个月; p = 0.029）。在所有435例患者中，Akaike信息标准的ALBI分级（MST：1级vs. 2 = 16.9 vs. 10.4个月; p = 0.001）也优于CP（MST：评分5 vs. 6 = 14.4 vs. 10.5个月; p = 0.003）（3195.6 vs. 3197.5）。结论：r-TACE期间肝功能下降的患者比例，特别是ALBI分级，并不低。在接受索拉非尼治疗的患者中，ALBI分级被证明是比CP更好的肝功能评估工具。在肝功能降级之前，需要对不能切除的HCC患者的TACE难治性状态进行严格判断，以改善预后。(C)2017 S. Karger AG，巴塞尔
Background/Aim: We evaluated the relationship of hepatic function with repeated transarterial catheter chemoembolization (TACE) and prognosis after sorafenib treatment in various patient cohorts. Methods: Study 1 comprised of 212 Barcelona clinic liver cancer stage-B (BCLC-B) HCC patients classified as Child-Pugh A (CP-A) and who had received repeated TACE treatments (r-TACE) (naive: recurrence = 66: 146). Study 2 comprised of 435 patients with unresectable HCC classified as CP-A in who sorafenib was introduced (naive: recurrence = 37: 398; CP score 5: 6 = 282: 153; macrovessel invasion [MVI]+: extrahepatic metastasis [EHM]+ both negative = 124: 226: 143). Changes in hepatic function along with CP and albumin-bilirubin (ALBI) score/grade during r-TACE in Study 1, and prognosis after introducing sorafenib in Study 2 were evaluated. Results: Hepatic function worsened to CP-B in 9-14% with each TACE procedure, while 18-21% had a change of classification from ALBI-1 to ALBI-2. When the prognosis of patients with the best CP score of 5 was analyzed, those with ALBI-1 (n = 154) had a better outcome than those with ALBI-2 (n = 128) (MST 17.5 vs. 9.9 months; p = 0.01), while ALBI-1 (n = 43) patients also showed a better outcome than ALBI-2 (n = 34) patients with a CP score of 5 without MVI/EHM (MST: 17.5 vs. 10.0 months; p = 0.029). The Akaike's Information criterion for ALBI-grade (MST: grade 1 vs. 2 = 16.9 vs. 10.4 months; p = 0.001) was also better than that for CP (MST: score 5 vs. 6 = 14.4 vs. 10.5 months; p = 0.003) (3195.6 vs. 3197.5) in all 435 patients. Conclusion: The rate of patients with downgraded hepatic function during r-TACE, especially with regard to ALBI-grade, was not low. ALBI-grade was shown to be a better hepatic function assessment tool than CP in patients receiving sorafenib treatment. Strict judgment of TACE-refractory status in patients with unresectable HCC is needed to improve prognosis before downgrading the hepatic function. (C) 2017 S. Karger AG, Basel