Lin Junqing, Jiang Han, Yang Weizhu, Jiang Na, Zheng Qubin, Huang Ning, Wang Xiaolong, Li Ang, Huang Jingyao
Department of Interventional Radiology, Fujian Medical University Union Hospital, Fuzhou, China.
Department of Nuclear Medicine, Fujian Medical University Union Hospital, Fuzhou, China.
Brachytherapy. 2019 Mar-Apr;18(2):233-239. doi: 10.1016/j.brachy.2018.10.002. Epub 2018 Nov 19.
The aims of this study were to evaluate treatment responses and predictive factors for overall survival (OS) in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) treated with iodine-125 (I) brachytherapy.
Seventy-seven HCC patients with PVTT underwent I brachytherapy after transcatheter arterial chemoembolization. Clinical, laboratory, and radiological evaluation were performed before and after treatment, as well as at 4-6 weeks intervals for 7 years to assess the efficacy and toxicity of therapy. Treatment response was assessed using modified response evaluation criteria in solid tumors. OS and predictive factors for each subgroup were evaluated after treatment.
In total, 11 patients (14.29%) achieved complete response, and 41 patients (53.25%) achieved partial response. The response rate (complete response + partial response) was 67.53% (52/77). The median OS was 9 months. The multivariable Cox regression model indicated that post-treatment tumor size with PVTT (p = 0.016, hazard ratio [HR] = 1.889, 95% confidence interval [CI]: 1.127 to 3.166) and baseline hemoglobin (p = 0.013, HR=0.518, 95% CI: 0.308 to 0.872) and alkaline phosphatase (p = 0.002, HR=2.275, 95% CI: 1.338 to 3.868) levels were significant independent predictors of OS.
I brachytherapy results in favorable treatment responses in HCC patients with PVTT. Notably, post-treatment tumor size and baseline hemoglobin and alkaline phosphatase levels are significant independent predictive factors for OS and provide the most predictive information regarding OS.
本研究旨在评估接受碘 - 125（I）近距离放射治疗的门静脉肿瘤血栓形成（PVTT）的肝细胞癌（HCC）患者的治疗反应及总生存期（OS）的预测因素。
77例伴有PVTT的HCC患者在经动脉化疗栓塞后接受I近距离放射治疗。在治疗前后以及之后7年每间隔4 - 6周进行临床、实验室及影像学评估，以评估治疗的疗效和毒性。使用实体瘤改良反应评估标准评估治疗反应。治疗后评估各亚组的总生存期及预测因素。
总计11例患者（14.29%）达到完全缓解，41例患者（53.25%）达到部分缓解。缓解率（完全缓解 + 部分缓解）为67.53%（52/77）。中位总生存期为9个月。多变量Cox回归模型表明，治疗后伴有PVTT的肿瘤大小（p = 0.016，风险比[HR] = 1.889，95%置信区间[CI]：1.127至3.166）、基线血红蛋白水平（p = 0.013，HR = 0.518，95%CI：0.308至0.872）以及碱性磷酸酶水平（p = 0.002，HR = 2.275，95%CI：1.338至3.868）是总生存期的显著独立预测因素。
I近距离放射治疗使伴有PVTT的HCC患者获得良好的治疗反应。值得注意的是，治疗后肿瘤大小、基线血红蛋白和碱性磷酸酶水平是总生存期的显著独立预测因素，并且提供了关于总生存期的最具预测性信息。
