Jung Jinhong, Joo Ji Hyeon, Kim So Yeon, Kim Jin Hyoung, Choi Jonggi, Lee Danbi, Shim Ju Hyun, Kim Kang Mo, Lim Young-Suk, Lee Han Chu, Park Jin-Hong, Yoon Sang Min
Department of Radiation Oncology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Radiology and the Research Institute of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Liver Cancer. 2021 Dec 7;11(2):152-161. doi: 10.1159/000521227. eCollection 2022 Apr.
We evaluated the radiologic response rate of combined transarterial chemoembolization (TACE) plus radiotherapy (RT) in treatment-naïve patients with liver-confined hepatocellular carcinoma (HCC) with macroscopic vascular invasion (MVI) and analyzed its clinical importance in overall survival (OS) outcomes.
Patients who were treated with TACE plus RT as a first-line treatment for HCC with MVI between January 2010 and December 2015 were retrospectively reviewed. Radiologic response was assessed according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) at 2 and 4 months after completion of RT. Landmark analysis at 2 and 4 months, and time-dependent Cox regression analysis using response as a time-dependent covariate were performed for univariable and multivariable analyses.
The 2-month landmark analysis included 427 patients, and the 4-month landmark analysis included 355 patients after excluding patients without imaging studies for response evaluation at 4 months. Radiologic responses were observed in 210 (49.2%) patients at 2 months and 181 (51.8%) patients at 4 months. In multivariable analyses, radiologic response was identified as an independent prognosticator for OS at 2 months (median OS: responders, 23.1 months vs. nonresponders, 8.0 months; hazard ratio [HR], 3.194; < 0.001) and 4 months (median OS: responders, 26.5 months vs. nonresponders, 9.3 months; HR, 4.534; < 0.001).
Radiologic response assessed by mRECIST was a significant prognostic factor for OS in patients with advanced-stage HCC showing MVI treated with combined TACE plus RT.
我们评估了经动脉化疗栓塞术（TACE）联合放疗（RT）对初治的局限于肝脏且伴有宏观血管侵犯（MVI）的肝细胞癌（HCC）患者的放射学缓解率，并分析了其在总生存期（OS）结局中的临床重要性。
回顾性分析了2010年1月至2015年12月期间接受TACE联合RT作为伴有MVI的HCC一线治疗的患者。在放疗完成后2个月和4个月，根据改良实体瘤疗效评价标准（mRECIST）评估放射学缓解情况。进行了2个月和4个月的标志性分析，并将缓解作为时间依赖性协变量进行时间依赖性Cox回归分析，以进行单变量和多变量分析。
2个月的标志性分析纳入了427例患者，在排除4个月时未进行用于缓解评估的影像学检查的患者后，4个月的标志性分析纳入了355例患者。2个月时，210例（49.2%）患者出现放射学缓解；4个月时，181例（51.8%）患者出现放射学缓解。在多变量分析中，放射学缓解被确定为2个月时OS的独立预后因素（中位OS：缓解者为23.1个月，未缓解者为8.0个月；风险比[HR]为3.194；P<0.001）以及4个月时OS的独立预后因素（中位OS：缓解者为26.5个月，未缓解者为9.3个月；HR为4.534；P<0.001）。
对于接受TACE联合RT治疗的伴有MVI的晚期HCC患者，通过mRECIST评估的放射学缓解是OS的重要预后因素。
