甲胎蛋白标准与实体瘤改良疗效评价标准对经动脉化疗栓塞术后肝细胞癌患者总生存期预测的比较
Comparison of α-Fetoprotein Criteria and Modified Response Evaluation Criteria in Solid Tumors for the Prediction of Overall Survival of Patients with Hepatocellular Carcinoma after Transarterial Chemoembolization.
作者信息
Zhang Ying-Qiang, Jiang Li-Juan, Wen Jia, Liu Di-Min, Huang Gui-Hua, Wang Yu, Fan Wen-Zhe, Li Jia-Ping
机构信息
Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, 628 Zhenyuan Rd., Shenzhen, P.R. China 518107; Department of Interventional Oncology, The First Affliatied Hospital, Sun Yat-sen University, Guangzhou, P.R. China.
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.
出版信息
J Vasc Interv Radiol. 2018 Dec;29(12):1654-1661. doi: 10.1016/j.jvir.2018.07.031. Epub 2018 Nov 3.
PURPOSE
To evaluate the value of α-fetoprotein (AFP) classification criteria in predicting tumor response and patient survival and to discuss the agreement between AFP criteria and modified Response Evaluation Criteria In Solid Tumors (mRECIST).
MATERIALS AND METHODS
Between January 2011 and December 2014, 147 patients with unresectable hepatocellular carcinoma (HCC) with baseline AFP levels ≥ 400 ng/mL who underwent transarterial chemoembolization as initial treatment were retrospectively enrolled for AFP/imaging correlation analysis. AFP-based response was classified as complete response (CR) in cases of AFP level normalization, partial response (PR) in cases of > 50% decrease vs baseline, stable disease (SD) in cases of -50% to +30% change vs baseline, or progressive disease (PD) in cases of > 30% increase vs baseline. Intermethod agreement between the 2 methods was assessed by Cohen κ coefficient. Response rates according to AFP and mRECIST were compared, and the association between response rate and overall survival (OS) was evaluated.
RESULTS
The κ value for agreement between AFP criteria and mRECIST was 0.549 (ie, moderate), with objective response and disease control rates of 36.1% and 63.3% per AFP criteria and 34.7% and 46.3% per RECIST (P = .807 and P = .003), respectively. Although AFP criteria and mRECIST showed significantly prognostic strata for CR, PR, SD, and PD after chemoembolization (P < .001 for both), some overlap in radiologic PD survival curves was observed. The OS of AFP-based disease control (ie, CR/PR/SD) was significantly longer than that of AFP-based PD among patients with radiologic PD (9.0 vs 6.0 mo; P < .001).
CONCLUSIONS
The defined AFP response moderately correlated with mRECIST response and yielded accurate prognostic prediction in patients with HCC and AFP levels ≥ 400 ng/mL treated with chemoembolization.
目的
评估甲胎蛋白（AFP）分类标准在预测肿瘤反应及患者生存方面的价值，并探讨AFP标准与改良实体瘤疗效评价标准（mRECIST）之间的一致性。
材料与方法
回顾性纳入2011年1月至2014年12月期间147例基线AFP水平≥400 ng/mL、接受经动脉化疗栓塞作为初始治疗的不可切除肝细胞癌（HCC）患者，进行AFP/影像学相关性分析。基于AFP的反应分类如下：AFP水平正常化者为完全缓解（CR），较基线水平下降>50%者为部分缓解（PR），较基线水平变化在-50%至+30%之间者为疾病稳定（SD），较基线水平升高>30%者为疾病进展（PD）。采用Cohen κ系数评估两种方法之间的方法间一致性。比较基于AFP和mRECIST的缓解率，并评估缓解率与总生存期（OS）之间的关联。
结果
AFP标准与mRECIST之间的一致性κ值为0.549（即中等），基于AFP标准的客观缓解率和疾病控制率分别为36.1%和63.3%，基于RECIST的分别为34.7%和46.3%（P = 0.807和P = 0.003）。虽然AFP标准和mRECIST在化疗栓塞后的CR、PR、SD和PD方面显示出显著的预后分层（两者P均<0.001），但在放射学PD生存曲线中观察到一些重叠。在放射学PD患者中，基于AFP的疾病控制（即CR/PR/SD）患者的OS显著长于基于AFP的PD患者（9.0个月对6.0个月；P < 0.001）。
结论
所定义的AFP反应与mRECIST反应具有中度相关性，并且在接受化疗栓塞治疗、AFP水平≥400 ng/mL的HCC患者中能得出准确的预后预测。
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