Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL.
Department of Medicine, Division of Hepatology, Northwestern University, Chicago, IL.
Hepatology. 2018 Mar;67(3):873-883. doi: 10.1002/hep.29480. Epub 2018 Jan 26.
Does imaging response predict survival in hepatocellular carcinoma (HCC)? We studied the ability of posttherapeutic imaging response to predict overall survival. Over 14 years, 948 patients with HCC were treated with radioembolization. Patients with baseline metastases, vascular invasion, multifocal disease, Child-Pugh > B7, and transplanted/resected were excluded. This created our homogeneous study cohort of 134 patients with Child-Pugh ≤ B7 and solitary HCC. Response (using European Association for Study of the Liver [EASL] and Response Evaluation Criteria in Solid Tumors 1.1 [RECIST 1.1] criteria) was associated with survival using Landmark and risk-of-death methodologies after reviewing 960 scans. In a subanalysis, survival times of responders were compared to those of patients with stable disease (SD) and progressive disease (PD). Uni/multivariate survival analyses were performed at each Landmark. At the 3-month Landmark, responders survived longer than nonresponders by EASL (hazard ratio [HR], 0.46; confidence interval [CI], 0.26-0.82; P = 0.002) but not RECIST 1.1 criteria (HR, 0.70; CI, 0.37-1.32; P = 0.32). At the 6-month Landmark, responders survived longer than nonresponders by EASL (HR, 0.32; CI, 0.15-0.77; P < 0.001) and RECIST 1.1 criteria (HR, 0.50; CI, 0.29-0.87; P = 0.021). At the 12-month Landmark, responders survived longer than nonresponders by EASL (HR, 0.34; CI, 0.15-0.77; P < 0.001) and RECIST 1.1 criteria (HR, 0.52; CI 0.27-0.98; P = 0.049). At 6 months, risk of death was lower for responders by EASL (P < 0.001) and RECIST 1.1 (P = 0.0445). In subanalyses, responders lived longer than patients with SD or PD. EASL response was a significant predictor of survival at 3-, 6-, and 12-month Landmarks on uni/multivariate analyses.
Response to radioembolization in patients with solitary HCC can prognosticate improved survival. EASL necrosis criteria outperformed RECIST 1.1 size criteria in predicting survival. The therapeutic objective of radioembolization should be radiologic response and not solely to prevent progression. (Hepatology 2018;67:873-883).
探讨肝癌（HCC）经治疗后影像学反应能否预测患者的总生存期。
我们研究了治疗后影像学反应预测总生存期的能力。14 年间，948 例 HCC 患者接受了放射性栓塞治疗。排除基线转移、血管侵犯、多发病灶、Child-Pugh＞B7 和移植/切除的患者。由此，我们创建了一个同质的研究队列，共纳入了 134 例 Child-Pugh≤B7 和单发 HCC 的患者。使用欧洲肝脏研究协会（EASL）和实体瘤反应评价标准 1.1（RECIST 1.1）标准，通过回顾 960 次扫描，用 Landmark 和死亡风险方法评估了患者的反应与生存的关系。在亚分析中，比较了反应者、疾病稳定（SD）和疾病进展（PD）患者的生存时间。在每个 Landmark 处进行单变量和多变量生存分析。在 3 个月的 Landmark 时，EASL 标准显示反应者的生存时间长于无反应者（风险比[HR]，0.46；95%置信区间[CI]，0.26-0.82；P=0.002），但 RECIST 1.1 标准（HR，0.70；95%CI，0.37-1.32；P=0.32）未显示出差异。在 6 个月的 Landmark 时，EASL 标准显示反应者的生存时间长于无反应者（HR，0.32；95%CI，0.15-0.77；P＜0.001）和 RECIST 1.1 标准（HR，0.50；95%CI，0.29-0.87；P=0.021）。在 12 个月的 Landmark 时，EASL 标准显示反应者的生存时间长于无反应者（HR，0.34；95%CI，0.15-0.77；P＜0.001）和 RECIST 1.1 标准（HR，0.52；95%CI，0.27-0.98；P=0.049）。在 6 个月时，EASL（P＜0.001）和 RECIST 1.1（P=0.0445）标准均显示反应者的死亡风险更低。在亚分析中，反应者的生存时间长于 SD 或 PD 患者。EASL 反应是在单变量和多变量分析中预测 3、6 和 12 个月 Landmark 时生存的重要预测指标。
单发 HCC 患者经放射性栓塞治疗后的反应可以预测生存时间的延长。EASL 坏死标准比 RECIST 1.1 大小标准更能预测生存。放射性栓塞治疗的治疗目标应该是影像学反应，而不仅仅是防止疾病进展。
