接受经动脉化疗栓塞术的肝细胞癌患者脾脏体积的预后价值
Prognostic value of splenic volume in hepatocellular carcinoma patients receiving transarterial chemoembolization.
作者信息
Dai Hai-Tao, Chen Bin, Tang Ke-Yu, Zhang Gui-Yuan, Wen Chun-Yong, Xiang Xian-Hong, Yang Jian-Yong, Guo Yan, Lin Run, Huang Yong-Hui
机构信息
Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
出版信息
J Gastrointest Oncol. 2021 Jun;12(3):1141-1151. doi: 10.21037/jgo-21-226.
BACKGROUND
Liver function is a key determinant for the survival of hepatocellular carcinoma (HCC) patients receiving transarterial chemoembolization (TACE). However, establishing robust prognostic indicators for liver insufficiencies and patient survival remains an unmet demand. This retrospective study evaluated the prognostic value of splenic volume (SV) in HCC patients undergoing TACE.
METHODS
A total of 67 HCC patients who underwent at least two consecutive TACE procedures were retrospectively included in this study. Comprehensive clinical information and follow-up data were collected, and the SV was measured based on dynamic contrast enhanced images. Risk factors of SV enlargement were assessed. The prognostic value of SV on survival was analyzed and compared with Child-Pugh (CP) classification and albumin-bilirubin (ALBI) grade.
RESULTS
The baseline SV was 299.74±143.63 cm, and showed a moderate and statistically significant correlation with CP classification (R=0.31, P<0.05). The SV increased remarkably after the first and second TACE procedures (330.16±155.38 cm, P<0.01, and 355.63±164.26 cm, P<0.01, respectively). In survival analysis, the optimal cut-off value of SV was determined as 373 cm using X-tile software, and the patients were divided into the small SV group and the large SV groups accordingly. Based on the pre-TACE SV, the median overall survival (mOS) for patients in the small SV group and the large SV group was 458 days and 249 days, respectively (P<0.05). After the first and second TACE, the mOS in the small SV group and the large SV group were 454 266 days (P<0.05) and 526 266 days (P<0.05), respectively. No prognostic value of CP classification and ALBI grade was identified for these patients. Furthermore, there were no significant differences between the small and large SV groups in age, tumor stage, and ALBI grade, except for CP classification (P<0.05).
CONCLUSIONS
SV was correlated with CP classification and was a robust predictor for HCC patients undergoing TACE treatment.
背景
肝功能是接受经动脉化疗栓塞术（TACE）的肝细胞癌（HCC）患者生存的关键决定因素。然而，建立针对肝功能不全和患者生存的可靠预后指标仍是未满足的需求。本回顾性研究评估了脾脏体积（SV）在接受TACE的HCC患者中的预后价值。
方法
本研究回顾性纳入了总共67例接受至少两次连续TACE手术的HCC患者。收集了全面的临床信息和随访数据，并基于动态对比增强图像测量了SV。评估了SV增大的危险因素。分析了SV对生存的预后价值，并与Child-Pugh（CP）分级和白蛋白-胆红素（ALBI）分级进行比较。
结果
基线SV为299.74±143.63 cm，与CP分级呈中度且具有统计学意义的相关性（R = 0.31，P < 0.05）。第一次和第二次TACE手术后SV显著增加（分别为330.16±155.38 cm，P < 0.01，和355.63±164.26 cm，P < 0.01）。在生存分析中，使用X-tile软件将SV的最佳截断值确定为373 cm，并据此将患者分为小SV组和大SV组。基于TACE前的SV，小SV组和大SV组患者的中位总生存期（mOS）分别为458天和249天（P < 0.05）。第一次和第二次TACE后，小SV组和大SV组的mOS分别为454天对266天（P < 0.05）和526天对266天（P < 0.05）。未发现CP分级和ALBI分级对这些患者具有预后价值。此外，除CP分级外（P < 0.05），小SV组和大SV组在年龄、肿瘤分期和ALBI分级方面无显著差异。
结论
SV与CP分级相关，是接受TACE治疗的HCC患者的可靠预测指标。
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