Department of Radiology, University Hospital Jena, Friedrich Schiller University, Jena, Germany.
Department of General, Visceral and Vascular Surgery, University Hospital Jena, Friedrich Schiller University, Jena, Germany.
Diagn Interv Radiol. 2021 Jan;27(1):85-93. doi: 10.5152/dir.2020.19439.
According to the Barcelona Clinic Liver Cancer (BCLC) staging classification, transarterial chemoembolization (TACE) is the treatment of choice for intermediate hepatocellular carcinoma (HCC). Thereby, the use of drug-eluting beads (DEB) as embolic agents has been recently established in clinical practice. The aim of this study was to evaluate tumor response after DEB-TACE.
This retrospective study was approved by the institutional ethics committee. Overall, 89 patients with HCC (Child Pugh A or B) receiving DEB-TACE as palliative treatment option or as bridging before liver transplantation were included in the study. Tumor response was assessed by modified response evaluation criteria in solid tumors (mRECIST) and a tumor growth rate. Survival analysis was performed using Kaplan-Meier estimator with log-rank testing and Cox proportional hazards.
A total of 188 TACE procedures were performed between 2006 and 2010. After the last intervention, 18% achieved complete response, 45% achieved partial response, 28% had stable disease and 9% had progressive disease. Using the tumor growth rate, 90% of all patients showed a tumor reduction between first and final response evaluation. The 6-month, 1-, 2- and 3-year overall survival rates were 86.5%, 67.4%, 47.2%, and 33.7%, with a median survival of 45, 24, 15, and 14 months for complete response, partial response, stable disease, and progressive disease, respectively. Tumor reduction showed a positive effect on survival.
DEB-TACE offers conclusive response results with mRECIST and proves a strong tendency of tumor reduction on survival benefits. Therefore, tumor growth rate represents a possible parameter to predict survival.
根据巴塞罗那临床肝癌（BCLC）分期分类，经动脉化疗栓塞（TACE）是治疗中晚期肝细胞癌（HCC）的首选方法。因此，载药微球（DEB）作为栓塞剂在临床实践中得到了广泛应用。本研究旨在评估 DEB-TACE 后的肿瘤反应。
这项回顾性研究得到了机构伦理委员会的批准。共有 89 例 HCC（Child Pugh A 或 B）患者接受 DEB-TACE 姑息治疗或作为肝移植前桥接治疗，纳入本研究。肿瘤反应通过改良实体瘤反应评估标准（mRECIST）和肿瘤生长率进行评估。采用 Kaplan-Meier 估计器和对数秩检验以及 Cox 比例风险进行生存分析。
2006 年至 2010 年期间共进行了 188 次 TACE 手术。末次干预后，18%的患者达到完全缓解，45%的患者达到部分缓解，28%的患者疾病稳定，9%的患者疾病进展。使用肿瘤生长率，所有患者中有 90%在首次和末次反应评估之间显示肿瘤缩小。6 个月、1 年、2 年和 3 年的总生存率分别为 86.5%、67.4%、47.2%和 33.7%，完全缓解、部分缓解、疾病稳定和疾病进展的中位生存期分别为 45、24、15 和 14 个月。肿瘤缩小对生存有积极影响。
DEB-TACE 具有明确的 mRECIST 反应结果，并证明肿瘤缩小对生存获益有强烈的趋势。因此，肿瘤生长率可能是预测生存的一个参数。
