Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea ; Department of Pharmacology, Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.
Department of Biostatics, Yonsei University College of Medicine, Seoul, Korea.
Cancer Res Treat. 2016 Jan;48(1):190-7. doi: 10.4143/crt.2014.276. Epub 2015 Mar 5.
The aim of this study was to evaluate whether hepatic arterial infusion concurrent chemoradiotherapy (CCRT) could improve overall survival (OS) in patients with locally advanced hepatocellular carcinoma (LAHCC).
Two databases were reviewed from Yonsei Cancer Center (YCC) and Korean Liver Cancer Study Group (KLCSG) nationwide multi-center hepatocellular carcinoma (HCC) cohort. The CCRT group included 106 patients, with stage III-IV, Child-Pugh classification A, Eastern Cooperative Oncology Group performance status 0 or 1, who underwent definitive CCRT as the initial treatment at YCC. We used propensity score matching to adjust for seven clinical factors, including age, tumor size, TNM stage by the Liver Cancer Study Group of Japan, T stage, Barcelona Clinic Liver Cancer (BCLC) staging system, etiology of HCC, and portal vein invasion, which all differed significantly in the two databases. From the KLCSG cohort enrolled at 32 institutions, 106 patients for the non-CCRT group were defined.
After propensity score matching, all patient characteristics were balanced between the two groups. The CCRT group had better OS (median, 11.4) than the non-CCRT group (6.6 months, p=0.02). In multivariate analyses for all patients, CCRT (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.11 to 1.97; p=0.007), tumor size (HR, 1.08; 95% CI, 1.04 to 1.12; p < 0.001), and BCLC stage (HR, 0.54; 95% CI, 0.36 to 0.8; p=0.003) were independent prognostic factors for OS.
CCRT showed better OS for LAHCC patients. In LAHCC patients with a good performance and normal liver function, CCRT could be a feasible treatment option. All of these findings need to be validated in prospective clinical trials.
本研究旨在评估肝动脉灌注化疗同步放疗（CCRT）是否能改善局部晚期肝细胞癌（LAHCC）患者的总生存期（OS）。
本研究回顾性分析了来自延世癌症中心（YCC）和韩国肝癌研究组（KLCSG）全国多中心肝细胞癌（HCC）队列的两个数据库。CCRT 组包括 106 例 III-IV 期、Child-Pugh 分级 A、东部肿瘤协作组体力状况 0 或 1 分、在 YCC 行根治性 CCRT 作为初始治疗的患者。我们使用倾向评分匹配调整了 7 个临床因素，包括年龄、肿瘤大小、日本肝癌研究组的 TNM 分期、T 分期、巴塞罗那临床肝癌（BCLC）分期系统、HCC 病因和门静脉侵犯，这两个数据库中的这些因素均有显著差异。从 KLCSG 队列的 32 个机构中，定义了 106 例非 CCRT 组患者。
经过倾向评分匹配后，两组患者的所有特征均平衡。CCRT 组的 OS（中位，11.4 个月）优于非 CCRT 组（6.6 个月，p=0.02）。对所有患者进行多变量分析，CCRT（风险比 [HR]，1.48；95%置信区间 [CI]，1.11 至 1.97；p=0.007）、肿瘤大小（HR，1.08；95%CI，1.04 至 1.12；p<0.001）和 BCLC 分期（HR，0.54；95%CI，0.36 至 0.8；p=0.003）是 OS 的独立预后因素。
CCRT 为 LAHCC 患者带来了更好的 OS。在肝功能正常、一般状况良好的 LAHCC 患者中，CCRT 可能是一种可行的治疗选择。所有这些发现都需要在前瞻性临床试验中得到验证。
