Kosaka Yumi, Kimura Tomoki, Kawaoka Tomokazu, Ogawa Yutaro, Amioka Kei, Naruto Kensuke, Yoshikawa Yuki, Kikukawa Chihiro, Suehiro Yosuke, Yamaoka Kenji, Ando Yuwa, Uchikawa Shinsuke, Morio Kei, Nakahara Takashi, Murakami Eisuke, Takahashi Shoichi, Tsuge Masataka, Hiramatsu Akira, Imamura Michio, Chosa Keigo, Awai Kazuo, Nagata Yasushi, Chayama Kazuaki, Aikata Hiroshi
Department of Gastroenterology and Metabolism, Hiroshima University, Hiroshima, Japan.
Therapeutic Radiology, Institute and Graduate School of Biomedical Science, and, Hiroshima University, Hiroshima, Japan.
Liver Cancer. 2021 Apr;10(2):151-160. doi: 10.1159/000513706. Epub 2021 Feb 24.
Overall survival of patients with advanced hepatocellular carcinoma (HCC) with Vp4 (tumor thrombosis of the main trunk or bilobar of the portal vein) is extremely poor.
The purpose of this study is to clarify the prognosis of hepatic arterial infusion chemotherapy (HAIC) combined with radiation therapy (RT) for advanced HCC with Vp4 and to analyze the factors that contribute to the prognosis.
In this retrospective cohort study, 51 HCC patients who were treated with HAIC and RT for portal vein tumor thrombosis and met the following criteria were enrolled: (i) with Vp4; (ii) Child-Pugh score of 5-7; (iii) Eastern Cooperative Oncology Group performance status of 0 or 1; (iv) no history of systemic therapy; and (v) from September 2004 to April 2019.
Median overall survival and median progression-free survival were 12.1 and 4.2 months, respectively. Multivariate analysis showed >50% of relative tumor volume in the liver (HR, 3.027; = 0.008) and extrahepatic spread with (HR, 3.773; = 0.040) as significant and independent factors of OS. The total overall response rate (ORR) was 19.6%; ORR in main tumor was 13.7%; and ORR in Vp4 was 51.0%. None of the patients who received HAIC combined with RT for advanced HCC with Vp4 developed hepatic failure. This combination therapy of HAIC with RT was safe and well tolerated in all cases.
Combination therapies of HAIC and RT might be good therapy for advanced HCC with Vp4.
伴有Vp4（门静脉主干或双侧支肿瘤血栓形成）的晚期肝细胞癌（HCC）患者的总生存期极差。
本研究旨在阐明肝动脉灌注化疗（HAIC）联合放射治疗（RT）用于伴有Vp4的晚期HCC的预后，并分析影响预后的因素。
在这项回顾性队列研究中，纳入了51例因门静脉肿瘤血栓形成而接受HAIC和RT治疗且符合以下标准的HCC患者：（i）伴有Vp4；（ii）Child-Pugh评分5 - 7分；（iii）东部肿瘤协作组体能状态为0或1；（iv）无全身治疗史；（v）2004年9月至2019年4月期间。
中位总生存期和中位无进展生存期分别为12.1个月和4.2个月。多因素分析显示肝脏相对肿瘤体积>50%（HR，3.027；P = 0.008）和肝外转移（HR，3.773；P = 0.040）是总生存期的显著且独立因素。总缓解率（ORR）为19.6%；主要肿瘤的ORR为13.7%；Vp4的ORR为51.0%。接受HAIC联合RT治疗的伴有Vp4的晚期HCC患者均未发生肝衰竭。HAIC与RT的这种联合治疗在所有病例中均安全且耐受性良好。
HAIC与RT的联合治疗可能是伴有Vp4的晚期HCC的良好治疗方法。
