Cavalcante Rafael Noronha, Nasser Felipe, Motta-Leal-Filho Joaquim M, Affonso Breno B, Galastri Francisco L, De Fina Bruna, Garcia Rodrigo G, Wolosker Nelson
Department of Interventional Radiology, Hospital Israelita Albert Einstein, 627 Albert Einstein Street, São Paulo, 05652-900, Brazil.
Cardiovasc Intervent Radiol. 2017 Jul;40(7):1044-1051. doi: 10.1007/s00270-017-1678-1. Epub 2017 May 12.
To evaluate incidence and predictive factors for the vascular lake phenomenon (VLP), as well as to compare local and overall tumor response in patients with and without VLP induced during DEB-TACE for HCC.
A total of 200 consecutive patients with 323 HCC nodules underwent first-session DEB-TACE from 2011 to 2014. Patients were divided in two groups, according to the presence of the VLP during DEB-TACE. Pre- and post-treatment imaging studies (CT or MRI) were performed. Primary endpoint was assessment of tumor response, evaluated by mRECIST. Comparison of response rates between the VLP group and the non-VLP group was performed. Secondary endpoints were the determination of incidence rate and predictive factors for the VLP.
The VLP was observed in 39/323 (12.1%) of the nodules treated. At multivariate logistic regression analysis, tumor size ≥3 cm in diameter (OR 13.95; 95% CI 3.60-54.05), presence of a pseudocapsule (OR 6.67; 95% CI 1.45-30.59) and alpha-fetoprotein levels (OR 1.004; 95% CI 1.000-1.007) remained predictive for the VLP occurrence. On a nodule-based analysis (p < 0.001), target lesion response analysis (p = 0.003) and overall response analysis (p = 0.004) the VLP group presented a higher objective response rate than the non-VLP group.
VLP is observed in 12% of the patients and happens more frequently in large and encapsulated tumors. It seems to be associated with better local and overall responses in HCC patients who underwent DEB-TACE.
评估血管湖现象（VLP）的发生率及预测因素，并比较在经动脉化疗栓塞术（DEB-TACE）治疗肝细胞癌（HCC）过程中出现和未出现VLP的患者的局部和整体肿瘤反应。
2011年至2014年，共有200例连续的患者、323个HCC结节接受了首次DEB-TACE治疗。根据DEB-TACE过程中是否存在VLP，将患者分为两组。进行了治疗前和治疗后的影像学检查（CT或MRI）。主要终点是通过改良的实体瘤疗效评价标准（mRECIST）评估肿瘤反应。对VLP组和非VLP组的反应率进行比较。次要终点是确定VLP的发生率和预测因素。
在接受治疗的323个结节中，有39个（12.1%）观察到VLP。在多因素逻辑回归分析中，直径≥3 cm的肿瘤（比值比[OR] 13.95；95%置信区间[CI] 3.60-54.05）、假包膜的存在（OR 6.67；95% CI 1.45-30.59）和甲胎蛋白水平（OR 1.004；95% CI 1.000-1.007）仍然是VLP发生的预测因素。在基于结节的分析（p < 0.001）、靶病变反应分析（p = 0.003）和整体反应分析（p = 0.004）中，VLP组的客观反应率高于非VLP组。
12%的患者观察到VLP，在大的和有包膜的肿瘤中更常见。它似乎与接受DEB-TACE治疗的HCC患者更好的局部和整体反应相关。
