Division of Vascular and Interventional Radiology, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
World J Gastroenterol. 2022 Jul 14;28(26):3232-3242. doi: 10.3748/wjg.v28.i26.3232.
Recently, hepatic arterial infusion chemotherapy (HAIC) plus lenvatinib has been frequently used to treat unresectable hepatocellular carcinoma (uHCC) in China. In the clinic, the hepatic arteries of some patients shrink significantly during this treatment, leading to improved short-term efficacy.
To investigate the relationship between the shrinkage of hepatic arteries and the short-term effect of HAIC plus lenvatinib treatment.
Sixty-seven participants with uHCC were enrolled in this retrospective study. The patients received HAIC every 3 wk, followed by oral lenvatinib after the first HAIC course. Hepatic artery diameters were measured on CT before treatment and after 1 and 2 mo of treatment. Meanwhile, the changes in tumor capillaries were also examined on pathological specimens before and after 1 mo of treatment. The antitumor response after 1, 3, and 6 mo of treatment was assessed using the modified Response Evaluation Criteria in Solid Tumors (mRECIST). The relationship between the changes in vessel diameters and the short-term effect of the combination treatment was evaluated by receiver-operating characteristic and logistic regression analyses.
The hepatic artery diameters were all significantly decreased after 1 and 2 mo of treatment ( < 0.001), but there was no difference in the vessel diameters between 1 and 2 mo ( > 0.05). The microvessel density in the tumor lesions decreased significantly after 1 mo of combination treatment ( < 0.001). According to mRECIST, 46, 41, and 24 patients had complete or partial responses after 1, 3, and 6 mo of treatment, respectively, whereas 21, 21, and 32 patients had a stable or progressive disease at these times, respectively. Shrinkage of the tumor-feeding artery was significantly associated with the tumor response after 1, 3, and 6 mo of treatment ( < 0.001, = 0.004, and = 0.023, respectively); however, changes in other hepatic arteries were not significantly associated with the tumor response. Furthermore, shrinkage of the tumor-feeding artery was an independent factor for treatment efficacy ( = 0.001, = 0.001, and = 0.002 and 1, 3, and 6 mo, respectively).
The hepatic arteries shrank rapidly after treatment with HAIC plus lenvatinib, and shrinkage of the tumor-feeding artery diameter was closely related to improved short-term efficacy.
最近，肝动脉灌注化疗（HAIC）加仑伐替尼已被广泛用于治疗中国不可切除的肝细胞癌（uHCC）。在临床上，一些患者的肝动脉在治疗过程中明显收缩，从而提高了短期疗效。
探讨肝动脉收缩与 HAIC 加仑伐替尼治疗短期疗效的关系。
本回顾性研究纳入 67 例 uHCC 患者。患者每 3 周接受一次 HAIC，第一次 HAIC 后口服仑伐替尼。在治疗前和治疗后 1、2 个月测量 CT 肝动脉直径。同时，在治疗后 1 个月的病理标本上检查肿瘤毛细血管的变化。治疗后 1、3、6 个月采用改良实体瘤反应评价标准（mRECIST）评估抗肿瘤反应。通过受试者工作特征和逻辑回归分析评估血管直径变化与联合治疗短期效果的关系。
治疗后 1 个月和 2 个月肝动脉直径均显著降低（<0.001），但 1 个月和 2 个月之间血管直径无差异（>0.05）。联合治疗后 1 个月肿瘤病灶内微血管密度明显下降（<0.001）。根据 mRECIST，治疗后 1、3、6 个月分别有 46、41、24 例患者完全或部分缓解，分别有 21、21、32 例患者病情稳定或进展。肿瘤供血动脉收缩与治疗后 1、3、6 个月的肿瘤反应显著相关（<0.001，=0.004，=0.023）；然而，其他肝动脉的变化与肿瘤反应无显著相关性。此外，肿瘤供血动脉收缩是治疗效果的独立因素（=0.001，=0.001，=0.002 和 1、3、6 个月）。
HAIC 加仑伐替尼治疗后肝动脉迅速收缩，肿瘤供血动脉直径收缩与短期疗效改善密切相关。
