Auer Timo A, Sofue Keitaro, Ueshima Eisuke, Rauer Nina, Yamaguchi Takeru, Gebauer Bernhard, Hamm Bernd, Murakami Takamichi, Althoff Christian E
Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany.
Berlin Institute of Health (BIH), Berlin, Germany.
J Hepatocell Carcinoma. 2022 Aug 1;9:695-705. doi: 10.2147/JHC.S359705. eCollection 2022.
The purpose of this study was to investigate outcomes of transarterial chemoembolization (TACE) in treating hepatocellular carcinoma (HCC) comparing the different approaches used in Germany and Japan.
This binational IRB-approved retrospective dual-center study included a total of 94 HCC patients subdivided in a German and a Japanese cohort. For each patient, liver and tumor volumetry was performed using computed tomography (CT) and magnetic resonance imaging (MRI). Furthermore, a comprehensive risk profile, including body constitution and liver and kidney function was established. Primary endpoints were progression-free and overall survival (PFS/OS).
PFS in the German cohort was 168 vs 224d in the Japanese cohort (=0.640). When subdivided by BCLC stage, no significant differences were reported (=0.160-0.429). OS was significantly longer in the Japanese cohort with 856 vs. 303d (<0.001). OS for BCLC A was significantly longer in the Japanese cohort (1960 vs. 428d; <0.001), while survival rates did not differ significantly in BCLC B (785 vs 330d; =0.067) and C-stages (208 vs 302d; =0.186). Older age (=0.034), poorer liver/kidney function (=0.025-0-035), and a higher liver/tumor ratio (<0.001) were found to correlate with shorter survival. ECOG scores were significantly higher in the German cohort (=0.002).
While OS is longer in TACE-treated patients in the Japanese cohort compared to the German cohort, the two approaches seem to be equally effective as PFS does not differ significantly. The different survival rates may be caused by the different clinical performance status of the selected collectives. In very early and early stage HCC, TACE in Japan seems to be an effective treatment option while in Germany for patients in those stages TACE remains a second-line option for patients not available for surgery or ablation.
本研究旨在比较德国和日本治疗肝细胞癌（HCC）的不同经动脉化疗栓塞（TACE）方法的疗效。
这项经双边机构审查委员会批准的回顾性双中心研究共纳入94例HCC患者，分为德国队列和日本队列。对每位患者，使用计算机断层扫描（CT）和磁共振成像（MRI）进行肝脏和肿瘤体积测量。此外，还建立了包括身体状况、肝肾功能在内的综合风险评估。主要终点是无进展生存期和总生存期（PFS/OS）。
德国队列的PFS为168天，日本队列为224天（=0.640）。按BCLC分期细分时，未报告显著差异（=0.160-0.429）。日本队列的OS明显更长，为856天对303天（<0.001）。日本队列中BCLC A期的OS明显更长（1960天对428天；<0.001），而BCLC B期（785天对330天；=0.067）和C期（208天对302天；=0.186）的生存率无显著差异。发现年龄较大（=0.034）、肝/肾功能较差（=0.025-0.035）和肝/肿瘤比值较高（<0.001）与较短生存期相关。德国队列的ECOG评分明显更高（=0.002）。
虽然日本队列中接受TACE治疗的患者的OS比德国队列更长，但两种方法似乎同样有效，因为PFS没有显著差异。不同的生存率可能是由所选群体的不同临床状况导致的。在极早期和早期HCC中，日本的TACE似乎是一种有效的治疗选择，而在德国，对于这些阶段的患者，TACE仍然是无法进行手术或消融的患者的二线选择。
