索拉菲尼治疗肝癌的疗效及预后因素分析
Correlation between SACE (Subjective Angiographic Chemoembolization Endpoint) score and tumor response and its impact on survival after DEB-TACE in patients with hepatocellular carcinoma.
机构信息
Department of General and Visceral Surgery and Surgical Oncology, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Germany.
Semmelweis Medical Faculty, Asklepios Campus Hamburg, Lohmühlenstraße 5, 20099, Hamburg, Germany.
出版信息
Abdom Radiol (NY). 2019 Oct;44(10):3463-3479. doi: 10.1007/s00261-019-02128-7.
PURPOSE
To asses angiographic and computed tomographic success criteria during and after transcatheter arterial drug-eluting bead chemoembolization (DEB-TACE) in patients with hepatocellular carcinoma (HCC) and its impact on progression-free survival (PFS) and overall survival (OS).
METHODS
In this retrospective single-center study, 50 patients with unresectable HCC having undergone DEB-TACE from January 2010 to July 2015 were assessed. The angiographic endpoint was classified by Subjective Angiographic Chemoembolization Endpoint (SACE) scale. Relative tumor density in arterial (D) and portal venous phase (D) computed tomography post- versus pre-DEB-TACE were calculated, respectively. Tumor response according to modified Response Criteria in Solid Tumors (mRECIST) was assessed. Univariate Kaplan-Meier and Cox regression analysis were carried out.
RESULTS
SACE scores I, II, III, and IV were found in 1 (2%), 20 (40%), 15 (30%), and 14 (28%) patients, respectively. Median OS and PFS were 14.2 and 5.5 months, respectively. Death rates at 6 months, 1 year and 2 years were 24%, 38%, and 52%, respectively. SACE score during DEB-TACE significantly correlated with local and overall mRECIST results (local: p < 0.001, r = 0.49, overall: p = 0.042, r = 0.29) and inversely correlated with D (p = 0.005, r = - 0.40). In univariate analysis, progressive disease (PD) according to mRECIST and increase of D and D were associated with significantly shorter PFS. Modified RECIST independently predicted OS (hazard ratio for complete remission vs. PD = 0.15, 95% confidence interval 0.03-0.68, p = 0.014).
CONCLUSIONS
A direct impact of SACE on PFS or OS could not be shown. However, SACE significantly correlated with local and overall mRECIST tumor response that again significantly predicted OS. We therefore postulate an indirect impact of SACE on OS. Consequently, complete embolization should be attempted.
目的
评估经导管动脉载药微球化疗栓塞术（DEB-TACE）治疗肝细胞癌（HCC）过程中和之后的血管造影和计算机断层扫描（CT）成功标准，及其对无进展生存期（PFS）和总生存期（OS）的影响。
方法
本回顾性单中心研究纳入了 2010 年 1 月至 2015 年 7 月期间接受 DEB-TACE 治疗的 50 例不可切除 HCC 患者。血管造影终点通过主观血管化学栓塞终点（SACE）量表进行分类。分别计算动脉期（D）和门静脉期（D）CT 后相对于 DEB-TACE 前的相对肿瘤密度。根据实体瘤反应评价标准（mRECIST）评估肿瘤反应。进行单因素 Kaplan-Meier 和 Cox 回归分析。
结果
1（2%）例患者的 SACE 评分分别为 I、II、III 和 IV，20（40%）例患者的 SACE 评分分别为 I、II、III 和 IV，15（30%）例患者的 SACE 评分分别为 I、II、III 和 IV，14（28%）例患者的 SACE 评分分别为 I、II、III 和 IV。中位 OS 和 PFS 分别为 14.2 和 5.5 个月。6 个月、1 年和 2 年的死亡率分别为 24%、38%和 52%。DEB-TACE 期间的 SACE 评分与局部和总体 mRECIST 结果显著相关（局部：p<0.001，r=0.49；总体：p=0.042，r=0.29），与 D 呈负相关（p=0.005，r=-0.40）。单因素分析显示，根据 mRECIST 判定的疾病进展（PD）和 D 和 D 的增加与 PFS 明显缩短相关。改良 RECIST 独立预测 OS（完全缓解与 PD 的风险比=0.15，95%置信区间 0.03-0.68，p=0.014）。
结论
不能证明 SACE 对 PFS 或 OS 有直接影响。然而，SACE 与局部和总体 mRECIST 肿瘤反应显著相关，而后者又显著预测 OS，我们因此推测 SACE 对 OS 有间接影响。因此，应尝试完全栓塞。
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