Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland.
Department of Radiology and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland; and
J Nucl Med. 2017 Aug;58(8):1334-1340. doi: 10.2967/jnumed.116.184713. Epub 2017 Jan 12.
The aim of this study was to compare survival of patients treated for unresectable hepatocellular carcinoma (uHCC) with Y transarterial radioembolization (TARE) using pretreatment partition model dosimetry (PMD). We performed a retrospective analysis of prospectively collected data on 77 patients consecutively treated (mean age ± SD, 66.4 ± 12.2 y) for uHCC (36 uninodular, 5 multinodular, 36 diffuse) with Y TARE (41 resin, 36 glass) using pretreatment PMD. Study endpoints were progression-free survival (PFS) and overall survival (OS) assessed by Kaplan-Meier estimates. Several variables including Barcelona Clinic Liver Cancer (BCLC) staging system, tumor size, and serum α-fetoprotein (AFP) level were investigated using Cox proportional hazards regression. The characteristics of 2 groups were comparable with regard to demographic data, comorbidities, Child-Pugh score, BCLC, serum AFP level, and Y global administered activity. The median follow-up time was 7.7 mo (range, 0.4-50.1 mo). Relapse occurred in 44 patients (57%) at a median of 6 mo (range, 0.4-27.9 mo) after Y TARE, and 41 patients (53%) died from tumor progression. Comparison between resin and glass microspheres revealed higher but not statistically significantly PFS and OS rates in the Y resin group than the Y glass group (resin PFS 6.1 mo [95% confidence interval CI, 4.7-7.4] and glass PFS 5 mo [95% CI, 0.9-9.2], = 0.53; resin OS 7.7 mo [95% CI, 7.2-8.2] and glass OS 7 mo [95% CI 1.6-12.4], = 0.77). No significant survival difference between both types of Y microspheres was observed in any subgroups of patients with early/intermediate or advanced BCLC stages. Among the variables investigated, Cox analyses showed that only in the glass group, the BCLC staging system and the serum AFP level were associated with PFS ( = 0.04) and OS ( = 0.04). Tumor size was a prognostic factor without significant influence on PFS and OS after Y TARE. Comparison between resin and glass microspheres revealed no significant survival difference in patients treated for uHCC with Y TARE using pretreatment PMD. Further, larger prospective studies are warranted to confirm these findings.
本研究旨在比较使用预处理分区模型剂量学（PMD）治疗不可切除肝细胞癌（uHCC）患者的生存率。我们对连续接受 Y 经动脉放射栓塞（TARE）治疗的 77 例患者的前瞻性收集数据进行了回顾性分析（平均年龄 ± 标准差，66.4 ± 12.2 岁），这些患者患有 uHCC（36 例单发结节，5 例多发结节，36 例弥漫性），采用 Y TARE（41 例树脂，36 例玻璃）进行治疗。使用 Kaplan-Meier 估计评估无进展生存期（PFS）和总生存期（OS）作为研究终点。使用 Cox 比例风险回归分析了包括巴塞罗那临床肝癌（BCLC）分期系统、肿瘤大小和血清甲胎蛋白（AFP）水平在内的几个变量。2 组的特征在人口统计学数据、合并症、Child-Pugh 评分、BCLC、血清 AFP 水平和 Y 总全身放射性活度方面相当。中位随访时间为 7.7 个月（范围 0.4-50.1 个月）。在 Y TARE 后 6 个月（范围 0.4-27.9 个月）中位数时，44 例患者（57%）出现复发，41 例患者（53%）因肿瘤进展而死亡。树脂微球和玻璃微球之间的比较显示，Y 树脂组的 PFS 和 OS 率高于 Y 玻璃组，但无统计学意义（树脂 PFS 6.1 个月[95%置信区间（CI），4.7-7.4]和玻璃 PFS 5 个月[95%CI，0.9-9.2]， = 0.53；树脂 OS 7.7 个月[95%CI，7.2-8.2]和玻璃 OS 7 个月[95%CI，1.6-12.4]， = 0.77）。在早期/中期或晚期 BCLC 分期的任何亚组患者中，两种类型的 Y 微球之间均未观察到显著的生存差异。在研究的变量中，Cox 分析显示，仅在玻璃组中，BCLC 分期系统和血清 AFP 水平与 PFS（ = 0.04）和 OS（ = 0.04）相关。肿瘤大小是一个预后因素，但在 Y TARE 后对 PFS 和 OS 没有显著影响。在使用预处理 PMD 治疗不可切除 HCC 患者的 Y TARE 中，树脂微球和玻璃微球之间的比较显示，生存率无显著差异。进一步需要更大规模的前瞻性研究来证实这些发现。
