Saito Natsuhiko, Nishiofuku Hideyuki, Sato Takeshi, Maeda Shinsaku, Minamiguchi Kiyoyuki, Taiji Ryosuke, Matsumoto Takeshi, Chanoki Yuto, Tachiiri Tetsuya, Kunichika Hideki, Marugami Nagaaki, Tanaka Toshihiro
Department of Diagnostic and Interventional Radiology, Nara Medical University, Shijyocho 840, Kashihara City 634-8522, Japan.
Department of Radiology, Higashiosaka City Medical Center, Nishiiwata 3-4-5, Higashiosaka City 578-8588, Japan.
Cancers (Basel). 2023 May 4;15(9):2609. doi: 10.3390/cancers15092609.
To clarify the prognosis and identify predictors for obtaining a complete response (CR) by transarterial chemoembolization (TACE) in intermediate stage HCC beyond up-to-7 criteria.
Of the 120 patients with intermediate stage HCC who were treated by TACE as the initial treatment from February 2007 to January 2016, 72 finally matched the following inclusion criteria: beyond up-to-7 criteria; Child-Pugh score under 7; and no combined therapy within 4 weeks after the initial TACE. The CR rate and overall survival (OS) were evaluated. Logistic regression analysis was performed to identify predictors of CR. The deterioration of liver function after TACE was also evaluated.
The CR rate was 56.9%, and the overall median survival time (MST) was 37.7 months. The MST was 38.7 months in the CR group and 28.0 months in the non-CR group ( = 0.018). HCC within up-to-11 criteria was the only predictor of CR. The CR rate and MST were 70.7% and 37.7 months, respectively, in patients with HCC within up-to-11 criteria and 38.7% and 32.7 months, respectively, in the patients beyond up-to-11 criteria. Deterioration of the Child-Pugh score after the initial TACE and the 2nd TACE occurred in 24.2% and 12.0%, respectively, and deterioration of the modified albumin-bilirubin (mALBI) grade occurred in 17.6% and 7.4%, respectively.
TACE can achieve high CR rates with prolonged overall survival for intermediate stage HCC beyond up-to-7 criteria. The predictor of CR was within up-to-11 criteria. Deterioration of liver function was not severe, but requires caution. Multidisciplinary approach as additional treatment after TACE is important.
明确超过up-to-7标准的中期肝细胞癌（HCC）经动脉化疗栓塞术（TACE）后的预后情况，并确定获得完全缓解（CR）的预测因素。
2007年2月至2016年1月期间，120例接受TACE作为初始治疗的中期HCC患者中，72例最终符合以下纳入标准：超过up-to-7标准；Child-Pugh评分低于7分；初次TACE后4周内未进行联合治疗。评估CR率和总生存期（OS）。进行逻辑回归分析以确定CR的预测因素。同时评估TACE后肝功能的恶化情况。
CR率为56.9%，总中位生存期（MST）为37.7个月。CR组的MST为38.7个月，非CR组为28.0个月（P = 0.018）。up-to-11标准内的HCC是CR的唯一预测因素。up-to-11标准内的HCC患者的CR率和MST分别为70.7%和37.7个月，超过up-to-11标准的患者分别为38.7%和32.7个月。初次TACE和第二次TACE后Child-Pugh评分恶化分别发生在24.2%和12.0%，改良白蛋白-胆红素（mALBI）分级恶化分别发生在17.6%和7.4%。
对于超过up-to-7标准的中期HCC，TACE可实现较高的CR率并延长总生存期。CR的预测因素是up-to-11标准内。肝功能恶化不严重，但需谨慎。TACE后采用多学科方法作为辅助治疗很重要。
