肝癌患者反复经动脉化疗栓塞术的动态风险评估的可行性。
Feasibility of dynamic risk assessment for patients with repeated trans-arterial chemoembolization for hepatocellular carcinoma.
机构信息
Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
Liver Cirrhosis Clinical Research Center, Seoul, South Korea.
出版信息
BMC Cancer. 2019 Apr 16;19(1):363. doi: 10.1186/s12885-019-5495-6.
BACKGROUND
Hepatoma arterial-embolization prognostic (HAP) score and its modifications (modified HAP [mHAP] and mHAP-II), consisting of some or all of the following factors of tumor size, number, alpha-fetoprotein, bilirubin, and serum albumin, have been found to predict outcomes after trans-arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). We investigated the feasibility of using HAP-related risk scores for dynamic risk assessment during repeated TACE.
METHODS
A total of 619 HCC patients treated with TACE from two institutions between 2003 and 2010 were included.
RESULTS
Patients with A-B class risk scores showed significantly better survival than those with C-D class risk scores at the first (median 43.7 vs. 21.5 months for mHAP-II, 35.2 vs. 10.2 months for mHAP, and 39.8 vs. 18.6 months for HAP; all P < 0.001) and the second rounds of TACE (38.6 vs. 17.2 months for mHAP-II, 30.0 vs. 8.5 months for mHAP, and 32.6 vs. 17.3 months for HAP; all P < 0.001). Sequential assessment of risk scores at the second TACE round was applied for patients with A-B class risk scores at the first TACE round, which further identified two subgroups of A-B and C-D class risk scores with different outcomes (median survival 40.6 vs. 19.6 months for mHAP-II, 31.2 vs. 16.9 months for mHAP, and 35.8 vs. 21.0 months for HAP; all P < 0.001). Compared with mHAP and HAP, mHAP-II showed the highest likelihood ratio (22.61 vs. 14.67 and 13.97, respectively), highest linear trend (24.43 vs. 19.67 and 14.19, respectively), and lowest Akaike information criteria value (1432.51 vs. 3412.29 and 2296.98, respectively).
CONCLUSIONS
All HAP-related risk scores dynamically predicted outcomes during repeated TACE. Sequential risk assessment using mHAP-II best identified optimal candidates for repeated TACE.
背景
肝癌动脉栓塞预后（HAP）评分及其改良版（改良 HAP [mHAP] 和 mHAP-II），由肿瘤大小、数量、甲胎蛋白、胆红素和血清白蛋白等因素组成，已被发现可预测肝细胞癌（HCC）经肝动脉化疗栓塞（TACE）后的预后。我们研究了 HAP 相关风险评分在重复 TACE 期间进行动态风险评估的可行性。
方法
纳入了 2003 年至 2010 年间两家机构接受 TACE 治疗的 619 例 HCC 患者。
结果
A-B 级风险评分患者的生存情况明显优于 C-D 级风险评分患者，在第一轮 TACE（mHAP-II 的中位生存期为 43.7 个月 vs. 21.5 个月，mHAP 为 35.2 个月 vs. 10.2 个月，HAP 为 39.8 个月 vs. 18.6 个月；均 P<0.001）和第二轮 TACE（mHAP-II 的中位生存期为 38.6 个月 vs. 17.2 个月，mHAP 为 30.0 个月 vs. 8.5 个月，HAP 为 32.6 个月 vs. 17.3 个月；均 P<0.001）中。在第一轮 TACE 中风险评分为 A-B 级的患者，在第二轮 TACE 中应用风险评分的序贯评估，进一步将 A-B 和 C-D 级风险评分分为具有不同结局的两个亚组（mHAP-II 的中位生存期为 40.6 个月 vs. 19.6 个月，mHAP 为 31.2 个月 vs. 16.9 个月，HAP 为 35.8 个月 vs. 21.0 个月；均 P<0.001）。与 mHAP 和 HAP 相比，mHAP-II 显示出最高的似然比（22.61 比 14.67 和 13.97）、最高的线性趋势（24.43 比 19.67 和 14.19）和最低的 Akaike 信息准则值（1432.51 比 3412.29 和 2296.98）。
结论
所有 HAP 相关风险评分均能动态预测重复 TACE 期间的预后。使用 mHAP-II 的序贯风险评估能最好地识别重复 TACE 的最佳候选者。
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