局部区域治疗对肝细胞癌的放射学反应可预测患者的生存时间。
Radiographic response to locoregional therapy in hepatocellular carcinoma predicts patient survival times.
机构信息
Department of Radiology, Section of Interventional Radiology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois 60611, USA.
出版信息
Gastroenterology. 2011 Aug;141(2):526-35, 535.e1-2. doi: 10.1053/j.gastro.2011.04.054. Epub 2011 Apr 30.
BACKGROUND & AIMS: It is not clear whether survival times of patients with hepatocellular carcinoma (HCC) are associated with their response to therapy. We analyzed the association between tumor response and survival times of patients with HCC who were treated with locoregional therapies (LRTs) (chemoembolization and radioembolization).
METHODS
Patients received LRTs over a 9-year period (n = 463). Patients with metastases, portal venous thrombosis, or who had received transplants were excluded; 159 patients with Child-Pugh B7 or lower were analyzed. Response (based on European Association for the Study of the Liver [EASL] and World Health Organization [WHO] criteria) was associated with survival times using the landmark, risk-of-death, and Mantel-Byar methodologies. In a subanalysis, survival times of responders were compared with those of patients with stable disease and progressive disease.
RESULTS
Based on 6-month data, in landmark analysis, responders survived longer than nonresponders (based on EASL but not WHO criteria: P = .002 and .0694). The risk of death was also lower for responders (based on EASL but not WHO criteria: P = .0463 and .707). Landmark analysis of 12-month data showed that responders survived longer than nonresponders (P < .0001 and .004, based on EASL and WHO criteria, respectively). The risk of death was lower for responders (P = .0132 and .010, based on EASL and WHO criteria, respectively). By the Mantel-Byar method, responders had longer survival than nonresponders, based on EASL criteria (P < .0001; P = .596 with WHO criteria). In the subanalysis, responders lived longer than patients with stable disease or progressive disease.
CONCLUSIONS
Radiographic response to LRTs predicts survival time. EASL criteria for response more consistently predicted survival times than WHO criteria. The goal of LRT should be to achieve a radiologic response, rather than to stabilize disease.
背景与目的
目前尚不清楚肝癌（HCC）患者的生存时间是否与其对治疗的反应有关。我们分析了接受局部区域治疗（LRT）（化疗栓塞和放射栓塞）的 HCC 患者的肿瘤反应与生存时间之间的关系。
方法
患者在 9 年内接受了 LRT（n=463）。排除有转移、门静脉血栓形成或接受过移植的患者；分析了 159 例 Child-Pugh B7 或更低的患者。使用里程碑、死亡风险和 Mantel-Byar 方法，根据欧洲肝脏研究协会（EASL）和世界卫生组织（WHO）标准，将反应（基于 EASL 和 WHO 标准）与生存时间相关联。在亚分析中，比较了应答者与稳定疾病和进展性疾病患者的生存时间。
结果
基于 6 个月的数据，在里程碑分析中，应答者的生存时间长于无应答者（基于 EASL 但不是 WHO 标准：P=0.002 和 0.0694）。应答者的死亡风险也较低（基于 EASL 但不是 WHO 标准：P=0.0463 和 0.707）。基于 EASL 和 WHO 标准，12 个月数据的里程碑分析显示，应答者的生存时间长于无应答者（P<0.0001 和 0.004）。应答者的死亡风险较低（P=0.0132 和 0.010，基于 EASL 和 WHO 标准，分别）。通过 Mantel-Byar 方法，根据 EASL 标准，应答者的生存时间长于无应答者（P<0.0001；P=0.596，根据 WHO 标准）。在亚分析中，应答者的生存时间长于稳定疾病或进展性疾病患者。
结论
LRT 的影像学反应预测生存时间。EASL 标准对反应的预测比 WHO 标准更一致地预测生存时间。LRT 的目标应该是实现影像学反应，而不是稳定疾病。
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