Gordon Andrew C, Gabr Ahmed, Riaz Ahsun, Uddin Omar M, Abouchaleh Nadine, Ali Rehan, Kallini Joseph, Salem Riad, Lewandowski Robert J
Section of Interventional Radiology, Department of Radiology, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.
Division of Hematology and Oncology, Department of Medicine, Northwestern University, Chicago, IL, USA.
Cardiovasc Intervent Radiol. 2018 Oct;41(10):1557-1565. doi: 10.1007/s00270-018-2008-y. Epub 2018 Jun 12.
To identify baseline characteristics and long-term prognostic factors in non-transplant patients with unresectable hepatocellular carcinoma (HCC) who had prolonged survival after treatment with yttrium-90 radioembolization (Y90).
Sixty-seven "Super Survivors" (defined as ≥ 3-year survival after Y90) were identified within our 1000-patient Y90 database (2003-2017). Baseline imaging and follow-up occurred at 1 month and every 3 months thereafter. Overall survival (OS) was calculated with Kaplan-Meier estimates with log-rank test in subgroups: Child-Pugh (CP) score, distribution of disease, portal vein thrombus (PVT), and technique (segmental vs lobar Y90).
Median age 69.5 years (range 45-94 years); 69% male; 60% solitary HCC; 79% unilobar disease; 12% PVT; 10% ascites; Barcelona Clinic Liver Cancer Stage A-54%/B-28%/C-16%/D-2%; CP A-70%/B-28%/C-2%. Longest baseline tumor diameter was 5.4 ± 4.0 cm (mean ± SD). All patients had an imaging response (either partial or complete response). Median OS was 67.5 months (95% CI 55.2-82.5). CP score and main PVT stratified median OS (p = 0.0007 and p = 0.0187, respectively). Beyond 3 years, segmental versus lobar Y90 was associated with improved OS with a median OS of 80.2 versus 46.7 months, respectively (p = 0.0024). Dosing > 200 Gy was not a significant predictor of improved OS.
Super Survivors spanning the BCLC staging system maintained durable OS after radioembolization that was stratified by the extent of underlying liver disease. The common variable among all patients was an imaging response. Segmental versus lobar Y90 may have a long-term associated OS benefit.
确定接受钇-90放射性栓塞（Y90）治疗后生存期延长的不可切除肝细胞癌（HCC）非移植患者的基线特征和长期预后因素。
在我们的1000例患者Y90数据库（2003 - 2017年）中识别出67例“超级幸存者”（定义为Y90治疗后生存期≥3年）。基线影像学检查在1个月时进行，此后每3个月进行一次随访。采用Kaplan-Meier估计法计算总生存期（OS），并在亚组中进行对数秩检验：Child-Pugh（CP）评分、疾病分布、门静脉血栓（PVT）和技术（节段性Y90与叶性Y90）。
中位年龄69.5岁（范围45 - 94岁）；69%为男性；60%为孤立性HCC；79%为单叶疾病；12%有PVT；10%有腹水；巴塞罗那临床肝癌分期A期 - 54%/B期 - 28%/C期 - 16%/D期 - 2%；CP A级 - 70%/B级 - 28%/C级 - 2%。基线肿瘤最长直径为5.4±4.0 cm（均值±标准差）。所有患者均有影像学反应（部分或完全反应）。中位OS为67.5个月（95%置信区间55.2 - 82.5）。CP评分和主要PVT对中位OS进行了分层（分别为p = 0.0007和p = 0.0187）。3年后，节段性Y90与叶性Y90相比，OS有所改善，中位OS分别为80.2个月和46.7个月（p = 0.0024）。剂量>200 Gy不是OS改善的显著预测因素。
跨越巴塞罗那临床肝癌分期系统的超级幸存者在放射性栓塞后维持了持久的OS，这由潜在肝脏疾病的程度分层。所有患者的共同变量是影像学反应。节段性Y90与叶性Y90相比可能具有长期的OS获益。
