Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
Department of Radiology, Konkuk University School of Medicine, Seoul, Korea.
Korean J Gastroenterol. 2020 Mar 25;75(3):147-156. doi: 10.4166/kjg.2020.75.3.147.
BACKGROUND/AIMS: A switch to systemic therapy, such as sorafenib, should be considered for hepatocellular carcinoma (HCC) patients refractory to transarterial chemoembolization (TACE). On the other hand, treatment changes are difficult if the liver function worsens to Child-Pugh B or C. Therefore, predicting the risk factors for non-responsiveness to TACE and deteriorating liver function may be helpful.
Newly diagnosed Child-Pugh A HCC patients who underwent TACE from January 2012 to June 2018 were included. After 1 year, this study evaluated whether there was a treatment response to TACE and whether the Child-Pugh class had worsened.
Among 121 patients, 65 were refractory and 56 responded to TACE. In multivariable logistic regression analysis, the tumor size, tumor number, and albumin at the time of the diagnosis of HCC were significant prognostic factors for the treatment response to TACE. Among 65 patients who presented TACE-refractoriness, 27 showed liver function deterioration from Child-Pugh class A to class B or C after TACE. In multivariable logistic regression analysis, bilirubin at the diagnosis of HCC was a significant prognostic factor for liver function deterioration. A predictive algorithm based on the regression equations revealed a sensitivity, specificity, positive predictive value, and negative predictive value of 74.1%, 74.5%, 45.5%, and 90.9%, respectively, for TACE-refractoriness and liver function deterioration.
The prognostic model incorporating the tumor size, tumor number, albumin, and bilirubin at the diagnosis of HCC may help identify patients who show a poor response to TACE and aggravation of liver function after TACE, who may benefit from early switching into systemic therapy before liver function aggravation.
背景/目的：对于经肝动脉化疗栓塞（TACE）治疗后耐药的肝细胞癌（HCC）患者，应考虑转为系统治疗，如索拉非尼。另一方面，如果肝功能恶化至 Child-Pugh B 或 C 级，治疗改变则较为困难。因此，预测对 TACE 无反应和肝功能恶化的风险因素可能有所帮助。
本研究纳入了 2012 年 1 月至 2018 年 6 月期间接受 TACE 治疗的初诊 Child-Pugh A HCC 患者。1 年后，评估患者对 TACE 的治疗反应以及 Child-Pugh 分级是否恶化。
在 121 例患者中，65 例患者对 TACE 耐药，56 例患者对 TACE 有反应。多变量逻辑回归分析显示，HCC 诊断时的肿瘤大小、肿瘤数量和白蛋白是 TACE 治疗反应的显著预后因素。在 65 例 TACE 耐药患者中，有 27 例患者在 TACE 后肝功能从 Child-Pugh A 级恶化至 B 级或 C 级。多变量逻辑回归分析显示，HCC 诊断时的胆红素是肝功能恶化的显著预后因素。基于回归方程的预测算法显示，TACE 耐药和肝功能恶化的敏感性、特异性、阳性预测值和阴性预测值分别为 74.1%、74.5%、45.5%和 90.9%。
纳入 HCC 诊断时肿瘤大小、肿瘤数量、白蛋白和胆红素的预后模型可能有助于识别 TACE 反应差和 TACE 后肝功能恶化的患者，这些患者可能受益于在肝功能恶化前尽早转为系统治疗。
