Wang Yingliang, Zhou Chen, Liu Jiacheng, Shi Qin, Huang Songjiang, Yang Chongtu, Li Tongqiang, Chen Yang, Xiong Bin
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China.
Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, People's Republic of China.
Cancer Manag Res. 2021 Sep 7;13:6935-6941. doi: 10.2147/CMAR.S328812. eCollection 2021.
In clinical practice, we found some of the patients who received transarterial chemoembolization (TACE) with molecular targeted agents (MTGs) plus immune checkpoint inhibitors (ICIs) for hepatocellular carcinoma (HCC) had obvious liquefactive necrosis formation within the tumor and some even progressed to a liver abscess, which seems more frequent than patients who received other treatments. Thus, we aim to identify this condition and analyze the potential risk factors.
Medical records of 72 consecutive patients with intermediate (BCLC B) and advanced (BCLC C) HCC who received TACE plus MTGs combined with (n=30) or without (n=42) ICIs were reviewed. Liquefactive necrosis formation was defined as the presence of obvious liquefactive necrosis within the tumor that required intervention.
The liquefactive necrosis rate was higher in the TACE+MTGs+ICIs group than in the TACE+MTGs group (30% vs 4.8%, P=0.006). Moreover, 18.2% (2/11) of the patients with liquefactive necrosis within the tumor had a bacterial infection. We then take the binary logistic regression analysis model to identify the predictors of liquefactive necrosis formation, and which showed the tumor size (P=0.006, OR=1.355, 95% CI: 1.090-1.684), alpha-fetoprotein level (P=0.036, OR=6.745, 95% CI: 1.130-40.262) and treatment modality (P=0.015, OR=11.717, 95% CI: 1.617-84.887) were the independent risk factor for liquefactive necrosis formation within the tumor.
Patients with HCC who received TACE combined with MTGs plus ICIs have increased liquefactive necrosis formation, and the larger tumor size and higher alpha-fetoprotein level were associated with more liquefactive necrosis formation within the tumor.
在临床实践中，我们发现一些接受经动脉化疗栓塞术（TACE）联合分子靶向药物（MTG）及免疫检查点抑制剂（ICI）治疗肝细胞癌（HCC）的患者，肿瘤内出现明显的液化坏死，部分甚至进展为肝脓肿，这似乎比接受其他治疗的患者更为常见。因此，我们旨在识别这种情况并分析潜在危险因素。
回顾了72例连续的中晚期（巴塞罗那临床肝癌分期B期和C期）HCC患者的病历，这些患者接受了TACE联合MTG，其中30例联合ICI，42例未联合ICI。液化坏死形成定义为肿瘤内存在明显的液化坏死且需要干预。
TACE+MTG+ICI组的液化坏死率高于TACE+MTG组（30%对4.8%，P=0.006）。此外，肿瘤内有液化坏死的患者中有18.2%（2/11）发生了细菌感染。然后我们采用二元逻辑回归分析模型来识别液化坏死形成的预测因素，结果显示肿瘤大小（P=0.006，OR=1.355，95%CI：1.090-1.684）、甲胎蛋白水平（P=0.036，OR=6.745，95%CI：1.130-40.262）和治疗方式（P=0.015，OR=11.717，95%CI：1.617-84.887）是肿瘤内液化坏死形成的独立危险因素。
接受TACE联合MTG及ICI治疗的HCC患者液化坏死形成增加，肿瘤体积越大、甲胎蛋白水平越高，肿瘤内液化坏死形成越多。
