Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
Liver Int. 2013 Apr;33(4):605-15. doi: 10.1111/liv.12098. Epub 2013 Jan 11.
BACKGROUND & AIMS: Early prediction of tumour response and major adverse events (AEs), especially liver failure, in patients with hepatocellular carcinoma (HCC) is essential for maximizing the clinical benefits of sorafenib. To evaluate the usefulness of dynamic contrast-enhanced ultrasound (DCE-US) for the early prediction of tumour response and major AEs in HCC patients.
Thirty-seven HCC patients were started on a reduced dosage of sorafenib, subsequently increased to the standard dosage. Tumour response at 1 month was assessed by CT using the Response Evaluation Criteria in Solid Tumors (RECIST). Major AEs were defined as grade 3 or higher. DCE-US was performed before treatment (day 0) and on days 7, 14 and 28. Changes in perfusion parameters in the tumour and liver parenchyma between day 0 and later time points were compared between treatment responders and nonresponders based on RECIST and between patients who experienced major AEs and those who did not. Tumour results were also compared with progression-free survival (PFS) and overall survival (OS).
Tumour perfusion parameters based on the area under the time-intensity curve (AUC) were statistically significant, with AUC during washin on day 14, the most relevant for tumour response (P = 0.0016) and AUC during washin on day 7, the most relevant for both PFS (P = 0.009) and OS (P = 0.037). A decrease in total AUC between days 0 and 7 in the liver parenchyma was strongly correlated with major AEs (P = 0.0002).
DCE-US may be useful for the early prediction of tumour response and major AEs in patients with HCC.
早期预测肝癌（HCC）患者的肿瘤反应和主要不良事件（AE），特别是肝衰竭，对于最大限度地提高索拉非尼的临床获益至关重要。本研究旨在评估动态对比增强超声（DCE-US）在 HCC 患者中早期预测肿瘤反应和主要 AE 的作用。
37 例 HCC 患者开始服用索拉非尼低剂量，随后增加至标准剂量。采用实体瘤反应评估标准（RECIST）评估 1 个月时的肿瘤反应。主要 AE 定义为 3 级或更高。在治疗前（第 0 天）和第 7、14 和 28 天进行 DCE-US。根据 RECIST 比较治疗反应者和无反应者以及发生主要 AE 者和未发生主要 AE 者之间肿瘤和肝实质之间的灌注参数在第 0 天与之后时间点的变化。还将肿瘤结果与无进展生存期（PFS）和总生存期（OS）进行了比较。
基于时间-强度曲线下面积（AUC）的肿瘤灌注参数具有统计学意义，其中第 14 天洗脱期的 AUC 与肿瘤反应最相关（P=0.0016），第 7 天洗脱期的 AUC 与 PFS（P=0.009）和 OS（P=0.037）均最相关。肝实质中 0 天与 7 天之间的总 AUC 下降与主要 AE 密切相关（P=0.0002）。
DCE-US 可能有助于预测 HCC 患者的肿瘤反应和主要 AE。
