Huo Ya Ruth, Xiang Hao, Chan Michael Vinchill, Chan Christine
Bankstown-Campbelltown Hospital, South Western Sydney Clinical School, UNSW Medicine and the University, Sydney, New South Wales, Australia.
Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
J Med Imaging Radiat Oncol. 2019 Dec;63(6):802-811. doi: 10.1111/1754-9485.12971. Epub 2019 Nov 10.
This study investigates the outcomes and safety of 70-150 μm and 100-300 μm doxorubicin drug-eluting bead transarterial chemoembolisation (DEB-TACE) in patients with unresectable hepatocellular carcinoma (HCC).
Retrospective, cohort study of 51 patients treated with DEB-TACE for unresectable HCC was studied: 23 with 100-300 μm particles and 28 with 70-150 μm particles. Overall, survival (OS), progression-free survival (PFS), tumour response and prognostic factors were assessed.
The median OS of the entire cohort was 30 months. The median OS and median PFS for 70-150 μm particles were not reached, whilst for the 100-300 μm group, it was 29.2 months and 15.0 months, respectively. The 6-month, 1-year and 2-year OS for 70-150 μm was 96%, 86% and 85% versus the 100-300 μm particles size of 83%, 64% and 44%, respectively. At 1-month follow-up, patients treated with 70-150 μm had significantly better mRECIST tumour response compared to 100-300 μm (complete response 38.5% vs. 19%; partial response 57.7% vs. 42.9%; stable disease 0% vs. 4.8%; progressive disease 3.8% vs. 33.3%, P = 0.027). Patients treated with 100-300 μm DEBs were significantly more likely to have progressive disease on 1-month follow-up imaging compared those treated with 70-150 μm DEB sizes (odds ratio 7.15, P = 0.007). The 30-day mortality rate was similar between the two groups (3.6% for 70-150 μm vs. 4.3% for 100-300 μm). Multivariate analysis demonstrated entire cohort OS was significantly associated with BCLC stage (aHR: 10.5, P = 0.002), albumin (aHR: 15.0, P = 0.02) and ALP (aHR 62, P = 0.001).
DEB-TACE with 70-150 μm particles demonstrates improved 1-month objective tumour response compared to 100-300 μm, whilst having a similar safety profile. Elevated ALP, lower albumin and higher BCLC stage were significantly associated with poorer survival outcomes.
本研究调查了70 - 150μm和100 - 300μm阿霉素药物洗脱微球经动脉化疗栓塞术（DEB - TACE）在不可切除肝细胞癌（HCC）患者中的疗效和安全性。
对51例接受DEB - TACE治疗的不可切除HCC患者进行回顾性队列研究：23例使用100 - 300μm颗粒，28例使用70 - 150μm颗粒。评估总生存期（OS）、无进展生存期（PFS）、肿瘤反应和预后因素。
整个队列的中位OS为30个月。70 - 150μm颗粒组的中位OS和中位PFS未达到，而100 - 300μm组分别为29.2个月和15.0个月。70 - 150μm颗粒组的6个月、1年和2年OS分别为96%、86%和85%，而100 - 300μm颗粒组分别为83%、64%和44%。在1个月随访时，与100 - 300μm颗粒组相比，70 - 150μm颗粒组患者的改良RECIST肿瘤反应明显更好（完全缓解38.5%对19%；部分缓解57.7%对42.9%；疾病稳定0%对4.8%；疾病进展3.8%对33.3%，P = 0.027）。与70 - 150μm颗粒组相比，100 - 300μm DEB治疗的患者在1个月随访影像上出现疾病进展的可能性明显更高（优势比7.15，P = 0.007）。两组的30天死亡率相似（70 - 150μm组为3.6%，100 - 300μm组为4.3%）。多因素分析表明，整个队列的OS与BCLC分期（aHR：10.5，P = 0.002）、白蛋白（aHR：15.0，P = 0.02）和碱性磷酸酶（aHR 62，P = 0.001）显著相关。
与100 - 300μm颗粒相比，70 - 150μm颗粒的DEB - TACE在1个月时的客观肿瘤反应有所改善，同时具有相似的安全性。碱性磷酸酶升高、白蛋白降低和BCLC分期较高与较差的生存结果显著相关。
