Labeur Tim A, Takkenberg R Bart, Klümpen Heinz-Josef, van Delden Otto M
Cancer Center Amsterdam, Amsterdam, The Netherlands.
Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
Cardiovasc Intervent Radiol. 2019 Feb;42(2):230-238. doi: 10.1007/s00270-018-2118-6. Epub 2018 Nov 28.
Transarterial chemoembolization (TACE) for intermediate-stage hepatocellular carcinoma (HCC) is often repeated until unTACEable progression (UTP) occurs. There is little data on the various reasons for stopping TACE and its consequences for subsequent treatment and survival.
To assess the impact of the various reasons of UTP on survival and consequences for subsequent treatments.
Consecutive HCC patients who underwent TACE between 2003 and 2016 were analyzed retrospectively for the reason of TACE discontinuation. UTP was defined according to the EASL guidelines, considering radiological pattern of progression, liver function and performance status (PS). Overall and post-progression survival (OS, PPS) for different reasons of TACE discontinuation were compared. The correlation between time to untreatable progression by chemoembolization (TTUPc) and OS was analyzed.
One hundred and sixty-six patients (BCLC-A 40%, BCLC-B 54%, BCLC-C: 7%) were included, undergoing a median of 2 TACE procedures with a median OS of 22.1 months (95% CI 17.4-26.7). UTP occurred in 116 patients (70%) after a median TTUPc of 11.6 months (95% CI 7.8-15.4). There was a strong positive correlation (ρ = 0.816, p < 0.001) between TTUPc and OS. The main reason of UTP was radiological progression (61%), which was mostly intrahepatic (75%). Hepatic decompensation and worsening of PS were independent predictors of OS and PPS.
The majority of HCC patients treated with TACE have UTP due to intrahepatic tumor progression with preserved liver function and PS, making them potential candidates for subsequent liver-directed or systemic treatment. TTUPc may be a valuable surrogate endpoint for OS in patients treated with TACE.
Level II, prognosis study.
对于中期肝细胞癌（HCC），经动脉化疗栓塞术（TACE）通常会反复进行，直至出现无法进行TACE的进展（UTP）。关于停止TACE的各种原因及其对后续治疗和生存的影响的数据很少。
评估UTP的各种原因对生存以及后续治疗的影响。
对2003年至2016年间接受TACE的连续性HCC患者进行回顾性分析，以确定TACE中断的原因。根据欧洲肝脏研究学会（EASL）指南，结合进展的影像学模式、肝功能和体能状态（PS）来定义UTP。比较不同TACE中断原因的总生存期和进展后生存期（OS，PPS）。分析化疗栓塞至无法治疗进展的时间（TTUPc）与OS之间的相关性。
纳入了166例患者（巴塞罗那临床肝癌分期系统[BCLC]-A期占40%，BCLC-B期占54%，BCLC-C期占7%），中位接受2次TACE治疗，中位OS为22.1个月（95%置信区间[CI] 17.4 - 26.7）。116例患者（70%）出现UTP，中位TTUPc为11.月（95% CI 7.8 - 15.4）。TTUPc与OS之间存在强正相关（ρ = 0.816，p < 0.001）。UTP的主要原因是影像学进展（61%），其中大部分为肝内进展（75%）。肝失代偿和PS恶化是OS和PPS的独立预测因素。
大多数接受TACE治疗的HCC患者因肝内肿瘤进展且肝功能和PS保留而出现UTP，这使他们成为后续肝靶向治疗或全身治疗的潜在候选者。TTUPc可能是TACE治疗患者OS的一个有价值的替代终点。
二级，预后研究。
