Division of Interventional Radiology, Department of Radiology, University of Illinois Health, Chicago, Illinois.
Center for Clinical and Translational Science, University of Illinois at Chicago, Chicago, Illinois.
J Vasc Interv Radiol. 2019 Sep;30(9):1317-1324. doi: 10.1016/j.jvir.2019.03.024. Epub 2019 Jul 30.
To compare outcomes of unresectable hepatocellular-cholangiocarcinoma (HCC-CC) with hepatocellular carcinoma (HCC) after locoregional therapy (LRT).
Consecutive patients with histologically confirmed HCC-CC or HCC treated with LRT between 2007 and 2017 were retrospectively reviewed. Ten patients (8 men; median age, 60 y) with 12 HCC-CCs (mean diameter, 4.2 cm ± 1.9; mean number, 3.7 ± 3.3) treated with chemoembolization (n = 6), yttrium-90 radioembolization (n = 2), RF ablation (n = 1), or chemoembolization/RF ablation (n = 1) were compared with 124 patients (92 men; median age, 59 y) with 134 HCCs (mean diameter, 4.8 cm ± 4.0; mean number, 2.6 ± 2.2) treated with chemoembolization (n = 51), yttrium-90 radioembolization (n = 17), RF ablation (n = 41), or chemoembolization/RF ablation (n = 15). Propensity score-matched analysis with conditional logistic regression adjusted for age, sex, LRT modality, tumor-specific features, and Child-Pugh class. Tumor-volume doubling time (TVDT) before LRT and objective response rates were compared by Kruskal-Wallis and Fisher exact test; progression-free survival (PFS) and transplant-free survival (TFS) were compared by Cox proportional hazards model.
On univariate analysis, HCC-CC was associated with lower median TVDT (2.4 months vs 5.2 months, P = .03), objective response (30% vs 71%, P = .01), and median PFS (2.4 months vs 7.4 months, HR 4.3, 95% CI 2.2-8.4, P < .0001). Propensity score-matched analysis demonstrated greater distant progression (60% vs 30%, P = .003) and significantly shorter median PFS (2.4 months vs 6.0 months, HR 3.3, 95% CI 1.3-8.9, P = .017) for HCC-CC. No significant difference was observed in TFS (7.5 months vs 13.8 months, HR 1.5, 95% CI 0.4-6.1).
HCC-CC was associated with reduced PFS and greater distant progression after LRT compared with HCC, indicating a need for adjunctive treatment strategies to improve outcomes.
比较局部区域治疗（LRT）后不能切除的肝细胞癌-胆管细胞癌（HCC-CC）与肝细胞癌（HCC）的结局。
回顾性分析了 2007 年至 2017 年间接受 LRT 治疗的经组织学证实的 HCC-CC 或 HCC 连续患者。比较了 10 例（8 例男性；中位年龄 60 岁）接受化疗栓塞（n=6）、钇-90 放射性栓塞（n=2）、射频消融（n=1）或化疗栓塞/射频消融（n=1）治疗的 12 例 HCC-CC（平均直径 4.2 cm±1.9；平均数量 3.7±3.3）与 124 例（92 例男性；中位年龄 59 岁）接受化疗栓塞（n=51）、钇-90 放射性栓塞（n=17）、射频消融（n=41）或化疗栓塞/射频消融（n=15）治疗的 134 例 HCC（平均直径 4.8 cm±4.0；平均数量 2.6±2.2）。采用条件逻辑回归分析进行倾向评分匹配，调整年龄、性别、LRT 方式、肿瘤特异性特征和 Child-Pugh 分级。采用 Kruskal-Wallis 和 Fisher 精确检验比较 LRT 前肿瘤体积倍增时间（TVDT）和客观缓解率；采用 Cox 比例风险模型比较无进展生存期（PFS）和无移植生存期（TFS）。
单因素分析显示，HCC-CC 与较低的中位 TVDT（2.4 个月比 5.2 个月，P=0.03）、客观缓解率（30%比 71%，P=0.01）和中位 PFS（2.4 个月比 7.4 个月，HR 4.3，95%CI 2.2-8.4，P<0.0001）相关。倾向评分匹配分析显示，HCC-CC 患者远处进展发生率更高（60%比 30%，P=0.003），中位 PFS 明显更短（2.4 个月比 6.0 个月，HR 3.3，95%CI 1.3-8.9，P=0.017）。TFS 无显著差异（7.5 个月比 13.8 个月，HR 1.5，95%CI 0.4-6.1）。
与 HCC 相比，HCC-CC 患者 LRT 后 PFS 更短，远处进展更多，表明需要辅助治疗策略来改善结局。
