Department of Internal Medicine, Asan Liver Center, University of Ulsan College of Medicine, 388-1 Poongnap-2dong, Songpa-gu, Seoul 138-736, Korea.
Radiology. 2012 Feb;262(2):708-18. doi: 10.1148/radiol.11110282. Epub 2011 Dec 20.
PURPOSE: To identify differences in radiologic assessment methods and determine optimal imaging criteria for response evaluation in hepatocellular carcinoma (HCC) patients treated with chemoembolization. MATERIALS AND METHODS: Institutional review board approval was obtained, and patient informed consent was waived. The present study included 332 patients with intermediate stage HCC and Child-Pugh A cirrhosis who underwent serial chemoembolization. All measurable target lesions of 1 cm or larger in diameter were uni- and bidimensionally measured both at baseline and during follow-up. Intermodel agreement among the guidelines of the World Health Organization (WHO), Response Evaluation Criteria in Solid Tumors (RECIST), the European Association for the Study of the Liver (EASL), and modified RECIST (mRECIST) were examined. The most reliable model was selected on the basis of the correlation with survival prediction. RESULTS: The κ values of comparisons among WHO, RECIST, and mRECIST guidelines were less than 0.20, whereas the κ value for the comparison of EASL and mRECIST guidelines was 0.94. In patients with a partial response (PR), stable disease (SD), or progressive disease (PD), compared with patients with a complete response (CR), hazard ratios (HRs) for survival were 2.99 (95% confidence interval [CI]: 2.14, 4.17), 3.49 (95% CI: 1.71, 7.10), and 15.63 (95% CI: 9.51, 25.69), respectively, for EASL criteria. In patients with a PR, SD, or PD, compared with patients with a CR, the HRs were 2.75 (95% CI: 1.96, 3.87), 6.32 (95% CI: 3.67, 10.90), and 16.06 (95% CI: 9.76, 26.43), respectively, for mRECIST guidelines (P<.001). The C index for the multivariate model was 0.76 (95% CI: 0.72, 0.79) for both EASL and mRECIST guidelines, thus exhibiting satisfactory capability to help predict survival. The Cox regression model revealed that both mRECIST and EASL guidelines were independent predictors of overall survival (P<.001 for both). CONCLUSION: The enhancement models more accurately helped predict long-term survival in HCC patients treated with chemoembolization.
目的：确定在接受化疗栓塞治疗的肝细胞癌（HCC）患者中，用于评估反应的放射学评估方法的差异，并确定最佳的成像标准。
材料和方法：获得机构审查委员会的批准，并放弃了患者的知情同意。本研究纳入了 332 例接受序贯化疗栓塞治疗的中期 HCC 合并 Child-Pugh A 级肝硬化患者。在基线和随访期间，对所有直径为 1cm 或以上的可测量靶病灶进行单维和二维测量。检查世界卫生组织（WHO）、实体瘤反应评估标准（RECIST）、欧洲肝脏研究协会（EASL）和改良 RECIST（mRECIST）指南之间的模型间一致性。根据与生存预测的相关性，选择最可靠的模型。
结果：WHO、RECIST 和 mRECIST 指南之间的κ值小于 0.20，而 EASL 和 mRECIST 指南之间的κ值为 0.94。在部分缓解（PR）、稳定疾病（SD）或进展性疾病（PD）患者中，与完全缓解（CR）患者相比，EASL 标准的生存危险比（HR）分别为 2.99（95%置信区间[CI]：2.14，4.17）、3.49（95% CI：1.71，7.10）和 15.63（95% CI：9.51，25.69）。在 PR、SD 或 PD 患者中，与 CR 患者相比，mRECIST 标准的 HR 分别为 2.75（95% CI：1.96，3.87）、6.32（95% CI：3.67，10.90）和 16.06（95% CI：9.76，26.43）（P<.001）。EASL 和 mRECIST 指南的多变量模型的 C 指数分别为 0.76（95% CI：0.72，0.79），表明其具有良好的预测生存能力。Cox 回归模型显示，mRECIST 和 EASL 指南均为总生存的独立预测因素（均为 P<.001）。
结论：增强模型更准确地帮助预测接受化疗栓塞治疗的 HCC 患者的长期生存。
Eur J Gastroenterol Hepatol. 2013-5
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