Arizumi Tadaaki, Minami Tomohiro, Chishina Hirokazu, Kono Masashi, Takita Masahiro, Yada Norihisa, Hagiwara Satoru, Minami Yasunori, Ida Hiroshi, Ueshima Kazuomi, Kamata Ken, Minaga Kosuke, Komeda Yoriaki, Takenaka Mamoru, Sakurai Toshiharu, Watanabe Tomohiro, Nishida Naoshi, Kudo Masatoshi
Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
Dig Dis. 2017;35(6):583-588. doi: 10.1159/000480186. Epub 2017 Oct 17.
Tumors classified based on the Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC) are heterogeneous in nature. Previously, the Kinki criterion was proposed for a more precise subclassification of tumors in BCLC-stage B. However, tumors in sub-stage B2 include various size and number of HCCs even with the Kinki criteria, which could lead to heterogeneity for overall survival (OS). In this study, we assessed how the size and number of tumors affect the OS and time to progression (TTP) in patients with Kinki criteria stage B2 tumors and treated with transarterial chemoembolization (TACE).
Of 906 HCC patients treated with TACE at Kindai University Hospital, 236 patients with HCC considered as Kinki criteria stage B2 were examined. They were classified into the following 4 groups according to the maximum tumor diameter and number of tumors: B2a group, tumor size ≤6 cm and total number of tumors ≤6; B2b group, size ≤6 cm and number >6; B2c group, size >6 cm and number ≤6; and B2d group, size >6 cm and number >6. The OS and TTP of patients in each group were compared.
There were 131 patients (55.5%) in the B2a group, 58 (24.6%) in the B2b group, 41 (17.4%) in the B2c group, and 6 (0.03%) in the B2d group. Comparison of the survivals revealed that the median OS was 2.8 years (95% CI 2.0-3.5) in the B2a group, 2.8 years (95% CI 2.0-3.3) in the B2b group, 1.9 years (95% CI 0.8-4.0) in the B2c group, and 2.3 years (95% CI 1.2-ND [no data]) in the B2d group, respectively (p = 0.896). The median TTP in B2a, B2b, B2c, and B2d sub-substage HCC were13.2, 12.1, 13.8, and 11.5 months, respectively (p = 0.047). The median TTP in B2a + B2c sub-substage patients was longer than that in B2b + B2d sub-substage HCC patients (14.0 months and 10.4 months; p = 0.002).
No significant differences were observed in the OS among HCC patients subclassified based on the maximum tumor diameter and tumor number in Kinki criteria stage B2. Consequently, Kinki criteria stage B2 HCC is a homogeneous subgroup in terms of OS prediction. However, shorter TTP in B2b+B2c sub-substage HCC patients than that in B2a + B2c sub-substage HCC patients suggests that different treatment strategy, such as systemic therapy with targeted agents instead of TACE, may be suitable to preserve the liver function.
基于巴塞罗那临床肝癌（BCLC）分期的B期肝细胞癌（HCC）在本质上具有异质性。此前，提出了近畿标准用于对BCLC分期B期的肿瘤进行更精确的亚分类。然而，即使采用近畿标准，B2亚期的肿瘤仍包括各种大小和数量的HCC，这可能导致总生存期（OS）的异质性。在本研究中，我们评估了肿瘤的大小和数量如何影响符合近畿标准B2期肿瘤且接受经动脉化疗栓塞术（TACE）治疗的患者的OS和疾病进展时间（TTP）。
在近畿大学医院接受TACE治疗的906例HCC患者中，对236例被认为符合近畿标准B2期的HCC患者进行了检查。根据最大肿瘤直径和肿瘤数量将他们分为以下4组：B2a组，肿瘤大小≤6 cm且肿瘤总数≤6个；B2b组，大小≤6 cm且数量>6个；B2c组，大小>6 cm且数量≤6个；B2d组，大小>6 cm且数量>6个。比较了每组患者的OS和TTP。
B2a组有131例患者（55.5%），B2b组有58例（24.6%），B2c组有41例（17.4%），B2d组有6例（0.03%）。生存比较显示，B2a组的中位OS为2.8年（95%CI 2.0 - 3.5），B2b组为2.8年（95%CI 2.0 - 3.3），B2c组为1.9年（95%CI 0.8 - 4.0），B2d组为2.3年（95%CI 1.2 - 无数据[无数据]），（p = 0.896）。B2a、B2b、B2c和B2d亚亚期HCC的中位TTP分别为13.2、12.1、13.8和11.5个月（p = 0.047）。B2a + B2c亚亚期患者的中位TTP长于B2b + B2d亚亚期HCC患者（14.0个月和10.4个月；p = 0.002）。
在基于近畿标准B2期的最大肿瘤直径和肿瘤数量进行亚分类的HCC患者中，未观察到OS有显著差异。因此，就OS预测而言，近畿标准B2期HCC是一个同质亚组。然而，B2b + B2c亚亚期HCC患者的TTP短于B2a + B2c亚亚期HCC患者，这表明不同的治疗策略，如用靶向药物进行全身治疗而非TACE，可能适合于保护肝功能。
