Shen Jian, Wang Wan-Sheng, Zhu Xiao-Li, Ni Cai-Fang
Department of Interventional Radiology, First Affiliated Hospital, Soochow University, 188 Shizi Rd., Suzhou 215006, China.
Department of Interventional Radiology, First Affiliated Hospital, Soochow University, 188 Shizi Rd., Suzhou 215006, China.
J Vasc Interv Radiol. 2018 Dec;29(12):1678-1684. doi: 10.1016/j.jvir.2018.07.030. Epub 2018 Nov 2.
To assess the role of epithelial cell adhesion molecule (EpCAM)-positive circulating tumor cell (CTC) count in predicting survival outcomes of transcatheter arterial chemoembolization in patients with unresectable hepatocellular carcinoma (HCC).
EpCAM-positive CTC counts were prospectively determined via CellSearch in peripheral blood of 97 patients with unresectable HCC treated with chemoembolization. The impact of each CTC cutoff point on overall survival (OS) was evaluated by univariate Cox regression analysis. Based on hazard ratio, patients were divided into 3 groups with low (CTC count 0/1), moderate (CTC count 2-5), and high (CTC count ≥ 6) levels. Correlation of CTC counts with survival was assessed by Cox proportional-hazards model.
Eighty-nine patients met inclusion criteria and were enrolled. On multivariate Cox regression analysis, CTC count was found to be an independent predictor of OS (P = .049) and progression-free survival (PFS; P = .007) in patients treated with chemoembolization. After adjustment for confounding factors, mortality risks in the high- and moderate-level groups were 2.819 times (95% confidence interval [CI], 1.218-6.526; P = .016) and 1.301 times (95% CI, 0.630-2.685; P = .477) greater, respectively, than in the low-level group. The risk of progression was 3.705 fold higher in the high-level group (95% CI, 1.628-8.433; P = .002) and 1.648 fold higher in the moderate-level group (95% CI, 0.843-3.223; P = .144) vs the low-level group.
High EpCAM-positive CTC count predicts poor survival of patients with unresectable HCC treated with chemoembolization.
评估上皮细胞粘附分子（EpCAM）阳性循环肿瘤细胞（CTC）计数在预测不可切除肝细胞癌（HCC）患者经动脉化疗栓塞生存结局中的作用。
通过CellSearch前瞻性测定97例接受化疗栓塞治疗的不可切除HCC患者外周血中EpCAM阳性CTC计数。通过单因素Cox回归分析评估每个CTC临界值对总生存（OS）的影响。根据风险比，将患者分为低（CTC计数0/1）、中（CTC计数2 - 5）、高（CTC计数≥6）三组。通过Cox比例风险模型评估CTC计数与生存的相关性。
89例患者符合纳入标准并被纳入研究。多因素Cox回归分析显示，在接受化疗栓塞治疗的患者中，CTC计数是OS（P = 0.049）和无进展生存（PFS；P = 0.007）的独立预测因素。在调整混杂因素后，高、中水平组的死亡风险分别比低水平组高2.819倍（95%置信区间[CI]，1.218 - 6.526；P = 0.016）和1.301倍（95%CI，0.630 - 2.685；P = 0.477）。高水平组的进展风险比低水平组高3.705倍（95%CI，1.628 - 8.433；P = 0.002），中水平组比低水平组高1.648倍（95%CI，0.843 - 3.223；P = 0.144）。
高EpCAM阳性CTC计数预示着接受化疗栓塞治疗的不可切除HCC患者生存不良。
