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肝细胞癌患者经动脉放射性栓塞作为一线介入治疗及先前经动脉化疗栓塞后的疗效

Outcome of transarterial radioembolization in patients with hepatocellular carcinoma as a first-line interventional therapy and after a previous transarterial chemoembolization.

作者信息

Wagenpfeil Julia, Kupczyk Patrick Arthur, Bruners Philipp, Siepmann Robert, Guendel Emelie, Luetkens Julian Alexander, Isaak Alexander, Meyer Carsten, Kuetting Fabian, Pieper Claus Christian, Attenberger Ulrike Irmgard, Kuetting Daniel

机构信息

Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, Bonn, Germany.

Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, Germany.

出版信息

Front Radiol. 2024 Feb 20;4:1346550. doi: 10.3389/fradi.2024.1346550. eCollection 2024.

DOI:10.3389/fradi.2024.1346550

PMID:38445105

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10912470/

Abstract

PURPOSE

Due to a lack of data, there is an ongoing debate regarding the optimal frontline interventional therapy for unresectable hepatocellular carcinoma (HCC). The aim of the study is to compare the results of transarterial radioembolization (TARE) as the first-line therapy and as a subsequent therapy following prior transarterial chemoembolization (TACE) in these patients.

METHODS

A total of 83 patients were evaluated, with 38 patients having undergone at least one TACE session prior to TARE [27 male; mean age 67.2 years; 68.4% stage Barcelona clinic liver cancer (BCLC) B, 31.6% BCLC C]; 45 patients underwent primary TARE (33 male; mean age 69.9 years; 40% BCLC B, 58% BCLC C). Clinical [age, gender, BCLC stage, activity in gigabecquerel (GBq), Child-Pugh status, portal vein thrombosis, tumor volume] and procedural [overall survival (OS), local tumor control (LTC), and progression-free survival (PFS)] data were compared. A regression analysis was performed to evaluate OS, LTC, and PFS.

RESULTS

No differences were found in OS (95% CI: 1.12, = 0.289), LTC (95% CI: 0.003, = 0.95), and PFS (95% CI: 0.4, = 0.525). The regression analysis revealed a relationship between Child-Pugh score (= 0.005), size of HCC lesions (>10 cm) (= 0.022), and OS; neither prior TACE (Child-Pugh B patients; 95% CI: 0.120, = 0.729) nor number of lesions (>10; 95% CI: 2.930, = 0.087) correlated with OS.

CONCLUSION

Prior TACE does not affect the outcome of TARE in unresectable HCC.

摘要

目的

由于缺乏数据，关于不可切除肝细胞癌（HCC）的最佳一线介入治疗一直存在争议。本研究的目的是比较经动脉放射性栓塞（TARE）作为一线治疗以及在这些患者中作为经动脉化疗栓塞（TACE）后的后续治疗的结果。

方法

共评估了83例患者，其中38例患者在接受TARE之前至少接受过一次TACE治疗[男性27例；平均年龄67.2岁；巴塞罗那临床肝癌（BCLC）分期B期占68.4%，BCLC C期占31.6%]；45例患者接受了初次TARE治疗（男性33例；平均年龄69.9岁；BCLC B期占40%，BCLC C期占58%）。比较了临床数据[年龄、性别、BCLC分期、放射性活度（GBq）、Child-Pugh分级、门静脉血栓形成、肿瘤体积]和治疗数据[总生存期（OS）、局部肿瘤控制（LTC）和无进展生存期（PFS）]。进行回归分析以评估OS、LTC和PFS。

结果

在OS（95%置信区间：1.12，P = 0.289）、LTC（95%置信区间：0.003，P = 0.95）和PFS（95%置信区间：0.4，P = 0.525）方面未发现差异。回归分析显示Child-Pugh评分（P = 0.005）、HCC病变大小（>10 cm）（P = 0.022）与OS之间存在关联；既往TACE治疗（Child-Pugh B级患者；95%置信区间：0.120，P = 0.729）和病变数量（>10个；95%置信区间：2.930，P = 0.087）均与OS无关。