Bryant Mary K, Dorn David P, Zarzour Jessica, Smith J Kevin, Redden David T, Saddekni Souheil, Abdel Aal Ahmed Kamel, Gray Stephen H, Eckhoff Devin E, Dubay Derek A
Liver Transplant and Hepatobiliary Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
HPB (Oxford). 2014 Apr;16(4):327-35. doi: 10.1111/hpb.12149. Epub 2013 Aug 26.
Radiographical features associated with a favourable response to trans-arterial chemoembolization (TACE) are poorly defined for patients with hepatocellular carcinoma (HCC).
From 2008 to 2012, all first TACE interventions for HCC performed at the University of Alabama at Birmingham (UAB) were retrospectively reviewed. Only patients with a pre-TACE and a post-TACE computed tomography (CT) scan were included in the analyses (n = 115). HCC tumour response to TACE was quantified via the the modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria. Univariate and multivariable analyses were constructed.
The index HCC tumours experienced a > 90% or complete tumour necrosis in 59/115 (51%) of patients after the first TACE intervention. On univariate analysis, smaller tumour size, peripheral tumour location and arterial enhancement were associated with a > 90% or complete tumour necrosis, whereas, only smaller tumour size [odds ratio (OR) 0.62; 95% confidence interval (CI) 0.48, 0.81] and peripheral location (OR 6.91; 95% CI 1.75, 27.29) were significant on multivariable analysis. There was a trend towards improved survival in the patients that experienced a > 90% or complete tumour necrosis (P = 0.08).
Peripherally located smaller HCC tumours are most likely to experience a > 90% or complete tumour necrosis after TACE. Surprisingly, arterial-phase enhancement and portal venous-phase washout were not significantly predictive of TACE-induced tumour necrosis. The TACE response was not statistically associated with improved survival.
对于肝细胞癌（HCC）患者，经动脉化疗栓塞术（TACE）疗效良好相关的影像学特征尚不明确。
回顾性分析2008年至2012年在阿拉巴马大学伯明翰分校（UAB）进行的所有首次HCC-TACE治疗。分析仅纳入有TACE术前和术后计算机断层扫描（CT）的患者（n = 115）。HCC对TACE的肿瘤反应通过改良实体瘤疗效评价标准（mRECIST）进行量化。构建单变量和多变量分析。
在首次TACE治疗后，59/115（51%）的患者中，索引HCC肿瘤出现> 90%或完全肿瘤坏死。单变量分析显示，较小的肿瘤大小、外周肿瘤位置和动脉期强化与> 90%或完全肿瘤坏死相关，而多变量分析中只有较小的肿瘤大小[比值比（OR）0.62；95%置信区间（CI）0.48，0.81]和外周位置（OR 6.91；95%CI 1.75，27.29）具有统计学意义。肿瘤坏死> 90%或完全坏死的患者有生存改善趋势（P = 0.08）。
外周型较小的HCC肿瘤在TACE术后最有可能出现> 90%或完全肿瘤坏死。令人惊讶的是，动脉期强化和门静脉期廓清对TACE诱导的肿瘤坏死无显著预测价值。TACE反应与生存改善无统计学关联。
