Hung Ya-Wen, Lee I-Cheng, Chi Chen-Ta, Lee Rheun-Chuan, Liu Chien-An, Chiu Nai-Chi, Hwang Hsuen-En, Chao Yee, Hou Ming-Chih, Huang Yi-Hsiang
Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan.
Liver Cancer. 2021 Jul 22;10(6):629-640. doi: 10.1159/000517393. eCollection 2021 Nov.
For patients with intermediate-stage hepatocellular carcinoma (HCC), the definition of high tumor burden remains controversial. This study aimed to compare the prognostic value of different criteria of tumor burden in patients with intermediate-stage HCC undergoing transarterial chemoembolization (TACE).
From 2007 to 2019, 632 treatment-naive patients with intermediate-stage HCC undergoing TACE were retrospectively enrolled. We compared different criteria of tumor burden in discriminating radiologic response and survival, including up-to-7, up-to-11, 5-7, 7 lesions criteria, and newly proposed 7-11 criteria.
The proportions of patients classified as high tumor burden were varied by different criteria. Among the 5 criteria, 7-11 criteria have the best performance to discriminate complete response (CR) and overall survival (OS) after TACE. In patients with low, intermediate, and high tumor burden classified by 7-11 criteria, the CR rate was 21, 12, and 2.5%, respectively ( < 0.001), and the median OS was 33.1, 22.3, and 11.9 months, respectively ( < 0.001). By multivariate analysis, 7-11 criteria were significantly associated with CR (intermediate vs. high burden, odds ratio = 4.617, = 0.002; low vs. high burden, odds ratio = 8.675, < 0.001) and OS (intermediate vs. high burden, hazard ratio = 0.650, < 0.001; low vs. high burden, hazard ratio = 0.520, < 0.001). Seven to 11 criteria also had the lowest corrected Akaike information criteria, highest homogeneity value, and highest area under the receiver operating characteristic curve in predicting 1-, 2-, and 3-year mortality among all criteria.
Conventional definitions of tumor burden were not optimal for patients with intermediate HCC. The new 7-11 criteria had the best discriminative power in predicting radiologic response and survival in patients with intermediate-stage HCC undergoing TACE.
对于中期肝细胞癌（HCC）患者，高肿瘤负荷的定义仍存在争议。本研究旨在比较不同肿瘤负荷标准对接受经动脉化疗栓塞术（TACE）的中期HCC患者的预后价值。
回顾性纳入2007年至2019年632例初治的接受TACE的中期HCC患者。我们比较了不同肿瘤负荷标准在鉴别放射学反应和生存方面的差异，包括最多7个、最多11个、5 - 7个、7个病灶标准以及新提出的7 - 11个标准。
根据不同标准分类为高肿瘤负荷的患者比例有所不同。在这5个标准中，7 - 11个标准在鉴别TACE后的完全缓解（CR）和总生存期（OS）方面表现最佳。在根据7 - 11个标准分类为低、中、高肿瘤负荷的患者中，CR率分别为21%、12%和2.5%（<0.001），中位OS分别为33.1个月、22.3个月和11.9个月（<0.001）。多因素分析显示，7 - 11个标准与CR（中与高负荷，优势比 = 4.617，P = 0.002；低与高负荷，优势比 = 8.675，P < 0.001）和OS（中与高负荷，风险比 = 0.650，P < 0.001；低与高负荷，风险比 = 0.520，P < 0.001）显著相关。在预测1年、2年和3年死亡率方面，7至11个标准的校正Akaike信息准则最低，同质性值最高，受试者工作特征曲线下面积最大。
传统的肿瘤负荷定义对中期HCC患者并非最优。新的7 - 11个标准在预测接受TACE的中期HCC患者的放射学反应和生存方面具有最佳鉴别能力。
