Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
PLoS One. 2020 Mar 4;15(3):e0229696. doi: 10.1371/journal.pone.0229696. eCollection 2020.
BACKGROUND & AIM: In clinical practice, transarterial chemoembolization (TACE) has been widely used for the treatment of hepatocellular carcinoma (HCC) beyond as well as within guideline recommendations. Here we aimed to verify whether two consecutive non-responses could be an optimal criterion for creating a rule to stop TACE being performed on these patients.
This study evaluated 200 patients with HCC beyond the Milan criteria, initially treated with TACE. TACE response was determined using the mRECIST criteria via dynamic CT or MRI. Median follow-up duration was 23.9 months.
Within the 200 patients analyzed, 183 (91.5%) were male, with a total median age of 59.8 years. The mean size of the largest tumor was 6.8 cm, with 80 (40.0%) patients with ≥4 tumors. After the first TACE procedure, complete response, partial response, stable disease, or progressive disease were observed in 48 (24.0%), 87 (43.5%), 59 (29.5%) and 6 (3.0%) of patients, respectively. 45 (22.5%) patients showed no objective response (OR) following two consecutive TACE sessions. Of these, 28 received a subsequent TACE, with a 10.7% OR rate. Patients without OR showed poorer survival when compared to patients who achieved OR after repeated TACE. Multivariable analysis showed that size of the largest tumor >5cm and high alpha-fetoprotein of >200 ng/mL were significant factors associated with failure of OR to two consecutive TACE sessions.
Patients showing no OR to two consecutive TACE sessions will present a poor OR to subsequent TACE procedures. Early transition to systemic therapy may be advocated in such cases.
在临床实践中，经动脉化疗栓塞术（TACE）已广泛应用于肝癌（HCC）的治疗，超出了指南推荐的范围。在此，我们旨在验证连续两次无反应是否可以作为为这些患者停止 TACE 治疗的规则制定的最佳标准。
本研究评估了 200 例超出米兰标准的 HCC 患者，这些患者最初接受 TACE 治疗。TACE 反应通过动态 CT 或 MRI 下的 mRECIST 标准确定。中位随访时间为 23.9 个月。
在分析的 200 例患者中，183 例（91.5%）为男性，总中位年龄为 59.8 岁。最大肿瘤的平均大小为 6.8cm，80 例（40.0%）患者有≥4 个肿瘤。在第一次 TACE 手术后，48 例（24.0%）、87 例（43.5%）、59 例（29.5%）和 6 例（3.0%）患者分别出现完全缓解、部分缓解、稳定疾病或进展性疾病。45 例（22.5%）患者在连续两次 TACE 治疗后无客观反应（OR）。其中 28 例患者接受了后续 TACE，OR 率为 10.7%。与多次 TACE 后获得 OR 的患者相比，无 OR 的患者生存较差。多变量分析显示，最大肿瘤直径>5cm 和甲胎蛋白（AFP）>200ng/ml 是与连续两次 TACE 治疗无 OR 相关的显著因素。
连续两次 TACE 治疗无反应的患者对后续 TACE 治疗的反应较差。在这种情况下，提倡早期转向系统治疗。
