机构决定采用 Y90 作为原发性肝癌的主要治疗方法，依据是 1000 例患者的 15 年经验。

Institutional decision to adopt Y90 as primary treatment for hepatocellular carcinoma informed by a 1,000-patient 15-year experience.

机构信息

Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL.

Department of Medicine, Division of Hematology and Oncology, Northwestern University, Chicago, IL.

出版信息

Hepatology. 2018 Oct;68(4):1429-1440. doi: 10.1002/hep.29691. Epub 2018 Jan 29.

DOI:10.1002/hep.29691

PMID:29194711

Abstract

UNLABELLED

Yttrium-90 transarterial radioembolization (TARE) is a locoregional therapy (LRT) for hepatocellular carcinoma (HCC). In this study, we present overall survival (OS) outcomes in a 1,000-patient cohort acquired over a 15-year period. Between December 1, 2003 and March 31, 2017, 1,000 patients with HCC were treated with TARE as part of a prospective cohort study. A comprehensive review of toxicity and survival outcomes was performed. Outcomes were stratified by baseline Child-Pugh (CP) class, United Network for Organ Sharing (UNOS), and Barcelona Clinic Liver Cancer (BCLC) staging systems. Albumin and bilirubin laboratory toxicities were compared to baseline. OS outcomes were reported using censoring and intention-to-treat methodologies. All treatments were outpatient, with a median one treatment per patient. Five hundred six (51%) were CP A, 450 (45%) CP B, and 44 (4%) CP C. Two hundred sixty-three (26%) patients were BCLC A, 152 (15%) B, 541 (54%) C, and 44 (4%) D. Three hundred sixty-eight (37%) were UNOS T1/T2, 169 (17%) T3, 147 (15%) T4a, 223 (22%) T4b, and 93 (9%) N/M. In CP A patients, censored OS for BCLC A was 47.3 (confidence interval [CI], 39.5-80.3) months, BCLC B 25.0 (CI, 17.3-30.5) months, and BCLC C 15.0 (CI, 13.8-17.7) months. In CP B patients, censored OS for BCLC A was 27 (CI, 21-30.2) months, BCLC B 15.0 (CI, 12.3-19.0) months, and BCLC C 8.0 (CI, 6.8-9.5) months. Forty-nine (5%) and 110 (11%) patients developed grade 3/4 albumin and bilirubin toxicities, respectively.

CONCLUSION

Based on our experience with 1,000 patients over 15 years, we have made a decision to adopt TARE as the first-line transarterial LRT for patients with HCC. Our decision was informed by prospective data and incrementally reported demonstrating outcomes stratified by BCLC, applied as either neoadjuvant or definitive treatment. (Hepatology 2017).

摘要

目的

探讨钇 90 经动脉放射性栓塞术（TARE）作为局部区域治疗（LRT）在肝细胞癌（HCC）中的应用。本研究报道了 1000 例患者 15 年的总生存（OS）结果。

方法

2003 年 12 月 1 日至 2017 年 3 月 31 日，1000 例 HCC 患者接受 TARE 治疗，作为前瞻性队列研究的一部分。对毒性和生存结果进行了全面回顾。根据基线 Child-Pugh（CP）分级、美国器官共享网络（UNOS）和巴塞罗那临床肝癌（BCLC）分期系统进行分层。比较白蛋白和胆红素实验室毒性与基线。采用删失和意向治疗方法报告 OS 结果。所有治疗均为门诊治疗，每位患者中位数接受一次治疗。506 例（51%）为 CP A 级，450 例（45%）为 CP B 级，44 例（4%）为 CP C 级。263 例（26%）为 BCLC A 级，152 例（15%）为 B 级，541 例（54%）为 C 级，44 例（4%）为 D 级。368 例（37%）为 UNOS T1/T2 级，169 例（17%）为 T3 级，147 例（15%）为 T4a 级，223 例（22%）为 T4b 级，93 例（9%）为 N/M 级。在 CP A 患者中，BCLC A 的删失 OS 为 47.3（置信区间[CI]，39.5-80.3）个月，BCLC B 为 25.0（CI，17.3-30.5）个月，BCLC C 为 15.0（CI，13.8-17.7）个月。在 CP B 患者中，BCLC A 的删失 OS 为 27（CI，21-30.2）个月，BCLC B 为 15.0（CI，12.3-19.0）个月，BCLC C 为 8.0（CI，6.8-9.5）个月。分别有 49 例（5%）和 110 例（11%）患者出现 3/4 级白蛋白和胆红素毒性。