Liver Unit, Clinica Universidad de Navarra, Pamplona, Spain.
Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
Cardiovasc Intervent Radiol. 2020 Aug;43(8):1165-1172. doi: 10.1007/s00270-020-02444-2. Epub 2020 Mar 12.
In patients with advanced hepatocellular carcinoma (HCC) treated with sorafenib, post-progression survival (PPS) is marked by the pattern of progression. Our aim was to assess the influence of the pattern of progression to selective internal radiotherapy (SIRT) in PPS among patients with HCC.
A retrospective analysis of patients treated with SIRT between 2003 and 2015 was conducted, excluding those with a single nodule < 5 cm or with metastases. Four patterns of progression to SIRT were defined: target tumour growth, non-target tumour growth, new intrahepatic disease, and new extrahepatic disease. PPS was calculated from the time of progression based on RECIST 1.1 criteria.
Out of the 102 patients who met the selection criteria, 76 progressed after a median follow-up of 15 months. Median PPS was 6.5 months (95% CI 3.8-9.3 months). Patients who progressed at pre-existing lesions had a better PPS (median 12.5 months) than those who progressed with new lesions inside or outside the liver (median 4.2 months) (p = 0.02). In a Cox model adjusted by liver function and systemic inflammation, the pattern of progression had a hazard ratio of 1.64 (95% CI 0.92-2.93; p = 0.093).
In a cohort of HCC patients treated with SIRT, the pattern of progression associated with worst survival was the development of new intrahepatic lesions or extrahepatic metastases.
在接受索拉非尼治疗的晚期肝细胞癌（HCC）患者中，进展后生存（PPS）以进展模式为特征。我们的目的是评估 HCC 患者 PPS 中进展至选择性内放射治疗（SIRT）的进展模式的影响。
对 2003 年至 2015 年接受 SIRT 治疗的患者进行回顾性分析，排除单个结节<5cm 或有转移的患者。将进展至 SIRT 的进展模式定义为：靶肿瘤生长、非靶肿瘤生长、新的肝内疾病和新的肝外疾病。根据 RECIST 1.1 标准，从进展时间开始计算 PPS。
在符合选择标准的 102 例患者中，76 例在中位随访 15 个月后进展。中位 PPS 为 6.5 个月（95%CI 3.8-9.3 个月）。与新的肝内或肝外病变进展的患者相比，在原有病变进展的患者具有更好的 PPS（中位 12.5 个月）（p=0.02）。在调整肝功能和全身炎症的 Cox 模型中，进展模式的风险比为 1.64（95%CI 0.92-2.93；p=0.093）。
在接受 SIRT 治疗的 HCC 患者队列中，与最差生存相关的进展模式是新的肝内病变或肝外转移的发展。
