Chung Sung Won, Cho Heejin, Shin Hyunjae, Park Jeayeon, Kim Ju Yeon, Hong Ji Hoon, Hur Moon Haeng, Park Min Kyung, Lee Yun Bin, Yu Su Jong, Lee Myungsu, Kim Yoon Jun, Paeng Jin Chul, Yoon Jung-Hwan, Chung Jin Wook, Lee Jeong-Hoon, Kim Hyo-Cheol
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Front Oncol. 2023 Feb 28;13:1081479. doi: 10.3389/fonc.2023.1081479. eCollection 2023.
Although transarterial radioembolization (TARE) using yttrium-90 (Y) is a treatment option for large hepatocellular carcinoma (HCC), a fraction of patients are ineligible for TARE due to high lung shunt fraction (LSF).
We evaluated if treatment with transarterial chemoembolization (TACE), owing to TARE ineligibility was associated with early HCC progression. Consecutive patients with HCC who were initially TARE candidates were included. Patients with vascular invasion or metastasis were excluded. Primary endpoints were time-to-progression (TTP) and overall survival (OS). The secondary endpoint was objective response rate.
In total, 175 patients were included: 144 underwent TARE (TARE-eligible group) and 31 underwent TACE due to high LSF (TARE-ineligible group). This latter group had larger tumors (13.8 cm . 7.8 cm, <0.001) and higher MoRAL scores (1,385.8 . 413.3, =0.002) than the TARE-eligible group. After balancing baseline characteristics with an inverse probability of treatment weighting (IPTW), the TARE-ineligible group showed shorter TTP [adjusted hazard ratio (aHR)=2.16, 95% confidence interval (CI)=1.14-4.07, =0.02] and OS (aHR=1.80, 95% CI=0.85-3.80, =0.12), although the latter was not statistically significant. The TARE-ineligible group had a significantly lower objective response rate than the TARE-eligible group (9.7% . 56.9%, <0.001).
TARE-ineligible patients had larger tumors and higher MoRAL scores than TARE-eligible patients. Treatment with TACE, owing to high LSF, was associated with a shorter TTP even after balancing tumor size and MoRAL scores.
尽管使用钇-90（Y）的经动脉放射性栓塞（TARE）是治疗大型肝细胞癌（HCC）的一种选择，但由于肺分流分数（LSF）较高，一部分患者不符合TARE治疗条件。
我们评估了因不符合TARE治疗条件而接受经动脉化疗栓塞（TACE）治疗是否与早期HCC进展相关。纳入了最初符合TARE治疗条件的连续性HCC患者。排除有血管侵犯或转移的患者。主要终点是无进展生存期（TTP）和总生存期（OS）。次要终点是客观缓解率。
总共纳入了175例患者：144例接受了TARE治疗（TARE符合条件组），31例因LSF高而接受了TACE治疗（TARE不符合条件组）。后一组的肿瘤比TARE符合条件组更大（13.8 cm对7.8 cm，<0.001），且MoRAL评分更高（1385.8对413.3，=0.002）。在用治疗权重逆概率（IPTW）平衡基线特征后，TARE不符合条件组的TTP较短[调整后风险比（aHR）=2.16，95%置信区间（CI）=1.14 - 4.07，=0.02]，OS也较短（aHR=1.80，95%CI=0.85 - 3.80，=0.12），尽管后者无统计学意义。TARE不符合条件组的客观缓解率显著低于TARE符合条件组（9.7%对56.9%，<0.001）。
TARE不符合条件的患者比TARE符合条件的患者肿瘤更大，MoRAL评分更高。由于LSF高而接受TACE治疗，即使在平衡肿瘤大小和MoRAL评分后，仍与较短的TTP相关。
