Sun Jun, Xia Dongdong, Bai Wei, Li Xiaomei, Wang Enxing, Yin ZhanXin, Han Guohong
Department of Liver Disease and Digestive Interventional Radiology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi'an, Shaanxi, China.
Department of Liver Diseases and Interventional Radiology, Digestive Diseases Hospital, Xi'an International Medical Center Hospital, Northwestern University, Xi'an, Shaanxi, China.
Front Oncol. 2024 Apr 23;14:1405178. doi: 10.3389/fonc.2024.1405178. eCollection 2024.
The progression pattern of tumors has an impact on the survival of patients with advanced hepatocellular carcinoma (HCC) and has been applied in the design of clinical trials for multiple second-line drugs. Previous research results have been contradictory, and the clinical impact of different progression patterns and their role in survival are still in question.
The study aims to analyze the impact of different progression patterns and tumor burden size on survival of HCC patients, as well as their interactions, through a retrospective cohort study.
The study involved 538 patients who had undergone treatment with sorafenib and had shown radiographic progression. The progression pattern was analyzed using Cox regression by including an interaction term between progression pattern and tumor burden, which was then visualized through a graphical analysis. Tumor burden was categorized into low, medium, and high subgroups based on the six-and-twelve criteria, allowing for an exploration of the effect of progression pattern on survival in different tumor burden situations.
Compared to patients with only intrahepatic progression (NIH/IHG) with an overall survival (OS) of 14.1/19.9 months and post-progression survival (PPS) of 8.1/13.1 months respectively, patients with extrahepatic lesions (NEH/EHG) had worse overall and postprogressive survival (OS: 9.3/9.2 months, PPS: 4.9/5.1 months). The hazard ratio for extrahepatic progression (NEH/EHG) compared to intrahepatic progression (NIH/IHG) at low, medium, and high tumor burden were [HR 2.729, 95%CI 1.189-6.263], [HR 1.755, 95%CI 1.269-2.427], and [HR 1.117, 95%CI 0.832-1.499], respectively.
The study concluded that the interaction between the tumor progression patterns and tumor burden significantly affects the prognosis of HCC patients. As the tumor burden increases, the sensitivity of the patient's risk of death to the progression pattern decreases. These findings are valuable in personalized treatment and trial design.
肿瘤的进展模式对晚期肝细胞癌（HCC）患者的生存有影响，并已应用于多种二线药物的临床试验设计中。先前的研究结果相互矛盾，不同进展模式的临床影响及其在生存中的作用仍存在疑问。
本研究旨在通过回顾性队列研究，分析不同进展模式和肿瘤负荷大小对HCC患者生存的影响及其相互作用。
本研究纳入了538例接受过索拉非尼治疗且出现影像学进展的患者。通过纳入进展模式与肿瘤负荷之间的交互项，使用Cox回归分析进展模式，然后通过图形分析进行可视化。根据六和十二标准将肿瘤负荷分为低、中、高亚组，以探讨进展模式在不同肿瘤负荷情况下对生存的影响。
与仅肝内进展（NIH/IHG）的患者相比，其总生存期（OS）分别为14.1/19.9个月，进展后生存期（PPS）为8.1/13.1个月，肝外病变（NEH/EHG）的患者总生存期和进展后生存期更差（OS：9.3/9.2个月，PPS：4.9/5.1个月）。低、中、高肿瘤负荷下肝外进展（NEH/EHG）与肝内进展（NIH/IHG）相比的风险比分别为[HR 2.729，95%CI 1.189 - 6.263]、[HR 1.755，95%CI 1.269 - 2.427]和[HR 1.117，95%CI 0.832 - 1.499]。
该研究得出结论，肿瘤进展模式与肿瘤负荷之间的相互作用显著影响HCC患者的预后。随着肿瘤负荷增加，患者死亡风险对进展模式的敏感性降低。这些发现对个性化治疗和试验设计具有重要价值。
