中期肝细胞癌病例中新提出的经动脉化疗栓塞进展时间的验证

Validation of Newly Proposed Time to Transarterial Chemoembolization Progression in Intermediate-Stage Hepatocellular Carcinoma Cases.

作者信息

Izumoto Hirofumi, Hiraoka Atsushi, Ishimaru Yoshihiro, Murakami Tadashi, Kitahata Shogo, Ueki Hidetaro, Aibiki Toshihiko, Okudaira Tomonari, Miyamoto Yuji, Yamago Hiroka, Iwasaki Ryuichiro, Tomida Hideomi, Mori Kenichiro, Kishida Masato, Tsubouchi Eiji, Miyata Hideki, Ninomiya Tomoyuki, Kawasaki Hideki, Hirooka Masashi, Matsuura Bunzo, Abe Masanori, Hiasa Yoichi, Michitaka Kojiro, Kudo Masatoshi

机构信息

Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.

出版信息

Oncology. 2017;93 Suppl 1:120-126. doi: 10.1159/000481242. Epub 2017 Dec 20.

DOI:10.1159/000481242

PMID:29258105

Abstract

BACKGROUND/AIM: Determination of failure of transarterial chemoembolization (TACE) for treatment of Barcelona Clinic Liver Cancer stage B (BCLC-B) hepatocellular carcinoma (HCC) has become important because of the development of tyrosine kinase inhibitor (TKI) treatment. We evaluated the usefulness and efficacy of the newly proposed time to TACE progression (TTTP).

PATIENTS AND METHODS

From 2006 to 2016, 192 BCLC-B HCC patients [median age 72 years, male/female ratio = 149/43, Child-Pugh score 5/6/7 = 106/56/30, albumin-bilirubin (ALBI) grade 1/2 = 64/128, Kinki criteria B1/B2 = 64/128] were enrolled. TTTP was defined based on a previous report and first imaging performed 3 months after initial TACE had been used to obtain baseline images. The patients were divided into three groups according to TTTP (<5, 5-10, and ≥10 months; group I, II, and III, respectively). We evaluated the relationship between TTTP and overall survival (OS) as well as the prognostic factors for death.

RESULTS

The median number of TACE procedures was 4 (interquartile range 3-7). There was a moderate correlation between TTTP and OS (r = 0.527, 95% CI 0.416-0.622, p < 0.001). The median survival for group I (n = 78), II (n = 49), and III (n = 65) was 24.6, 34.7, and 49.5 months, respectively (group I vs. group II, p = 0.023; group I vs. group III, p < 0.001; group II vs. group III, p = 0.037; Holm's method). ALBI grade 2 (HR 1.548, 95% CI 1.004-2.388, p = 0.048), alpha-fetoprotein (>100 ng/mL) (HR 1.540, 95% CI 1.035-2.291, p = 0.033), and TTTP (<5 months) (HR 2.157, 95% CI 1.447-3.215, p < 0.001) were significant prognostic factors for death in multivariate Cox hazard analysis.

CONCLUSION

In patients with reduced TTTP, especially <5 months, it might be difficult to improve prognosis with a repeated TACE procedures. In such cases, reconsideration of the therapeutic strategy might be needed when possible.

摘要

背景/目的：由于酪氨酸激酶抑制剂（TKI）治疗的发展，确定经动脉化疗栓塞术（TACE）治疗巴塞罗那临床肝癌分期B（BCLC - B）肝细胞癌（HCC）的失败情况变得很重要。我们评估了新提出的TACE进展时间（TTTP）的实用性和有效性。

患者与方法

2006年至2016年，纳入了192例BCLC - B期HCC患者[中位年龄72岁，男/女比例 = 149/43，Child - Pugh评分5/6/7 = 106/56/30，白蛋白 - 胆红素（ALBI）分级1/2 = 64/128，近畿标准B1/B2 = 64/128]。TTTP根据先前的报告定义，首次成像在初始TACE后3个月进行，以获取基线图像。根据TTTP（<5、5 - 10和≥10个月；分别为I组、II组和III组）将患者分为三组。我们评估了TTTP与总生存期（OS）之间的关系以及死亡的预后因素。

结果

TACE手术的中位次数为4次（四分位间距3 - 7）。TTTP与OS之间存在中等程度的相关性（r = 0.527，95%CI 0.416 - 0.622，p < 0.001）。I组（n = 78）、II组（n = 49）和III组（n = 65）的中位生存期分别为24.6、34.7和49.5个月（I组与II组，p = 0.023；I组与III组，p < 0.001；II组与III组，p = 0.037；霍尔姆法）。ALBI 2级（HR 1.548，95%CI 1.004 - 2.388，p = 0.048）、甲胎蛋白（>100 ng/mL）（HR 1.540，95%CI 1.035 - 2.291，p = 0.033）和TTTP（<5个月）（HR 2.157，95%CI 1.447 - 3.215，p < 0.001）是多因素Cox风险分析中死亡的显著预后因素。