From the Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China (G.P., X.Y.H., X.J.C., X.Z.); and Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Zhengzhou, China (Y.N.W.).
Radiol Imaging Cancer. 2024 May;6(3):e230167. doi: 10.1148/rycan.230167.
Purpose To investigate the association of tumor arterial burden (TAB) on preoperative MRI with transarterial chemoembolization refractoriness (TACER) and progression-free survival (PFS) in patients with hepatocellular carcinoma (HCC). Materials and Methods This retrospective study included patients with HCC who underwent repeated transarterial chemoembolization (TACE) treatments between January 2013 and December 2020. HCC was confirmed with pathology or imaging, and patients with other tumors, lost follow-up, or with a combination of other treatments were excluded. TACER was defined as viable lesions of more than 50% or increase in tumor number after two or more consecutive TACE treatments, continuous elevation of tumor markers, extrahepatic spread, or vascular invasion. TAB assessed with preoperative MRI was divided into high and low groups according to the median. A Cox proportional hazards model was used to determine the predictors of TACER and PFS. Results A total of 355 patients (median age, 61 years [IQR, 54-67]; 306 [86.2%] men, 49 [13.8%] women) were included. During a median follow-up of 32.7 months, the high TAB group had significantly faster TACER and decreased PFS than the low TAB group (all log-rank < .001). High TAB was the strongest independent predictor of TACER and PFS in multivariable Cox regression analyses (hazard ratio [HR], 2.23 [95% CI: 1.51, 3.29]; HR, 2.30 [95% CI: 1.61, 3.27], respectively), especially in patients with Barcelona Clinic Liver Cancer stage A or a single tumor. The restricted cubic spline plot demonstrated that the HR of TACER and PFS continuously increased with increasing TAB. Conclusion High preoperative TAB at MRI was a risk factor for faster refractoriness and progression in patients with HCC treated with TACE. Interventional-Vascular, MR Angiography, Hepatocellular Carcinoma, Transarterial Chemoembolization, Progression-free Survival, MRI © RSNA, 2024.
目的 研究术前磁共振成像（MRI）肿瘤动脉负担（TAB）与肝细胞癌（HCC）患者经动脉化疗栓塞（TACE）耐药性和无进展生存期（PFS）的相关性。
材料与方法 本回顾性研究纳入了 2013 年 1 月至 2020 年 12 月期间接受重复 TACE 治疗的 HCC 患者。HCC 通过病理或影像学检查确诊，排除了患有其他肿瘤、失去随访或接受其他治疗联合治疗的患者。TACE 耐药性定义为两次或两次以上连续 TACE 治疗后活瘤比例>50%或肿瘤数量增加、肿瘤标志物持续升高、肝外扩散或血管侵犯。根据中位数，术前 MRI 评估的 TAB 分为高和低两组。采用 Cox 比例风险模型确定 TACE 和 PFS 的预测因素。
结果 共纳入 355 例患者（中位年龄，61 岁[IQR，54-67]；306 例[86.2%]为男性，49 例[13.8%]为女性）。在中位随访 32.7 个月期间，高 TAB 组的 TACE 耐药性和 PFS 显著快于低 TAB 组（所有 log-rank 均<.001）。多变量 Cox 回归分析显示，高 TAB 是 TACE 和 PFS 的最强独立预测因素（风险比[HR]，2.23[95%CI：1.51，3.29]；HR，2.30[95%CI：1.61，3.27]），尤其是在巴塞罗那临床肝癌分期 A 或单个肿瘤患者中。受限立方样条图显示，TACE 和 PFS 的 HR 随 TAB 的增加而连续增加。
结论 在接受 TACE 治疗的 HCC 患者中，术前 MRI 显示高 TAB 是快速耐药和进展的危险因素。
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