Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Department of Radiology, Keio University School of Medicine, Tokyo, Japan.
Sci Rep. 2024 May 13;14(1):10896. doi: 10.1038/s41598-024-61611-4.
Development of subclassification of intermediate-stage hepatocellular carcinoma (HCC) by treatment suitability is in demand. We aimed to identify predictors that define treatment refractoriness against locoregional(transarterial chemoembolization(TACE) or thermal ablation) and surgical therapy. This multicenter retrospective study enrolled 1167 HCC patients between 2015 and 2021. Of those, 209 patients were initially diagnosed with intermediate-stage HCC. Treatment refractoriness was defined as clinical settings that meets the following untreatable progressive conditions by TACE (1) 25% increase of intrahepatic tumor, (2) transient deterioration to Child-Pugh class C, (3) macrovascular invasion or extrahepatic spread, within one year. We then analyzed factors contributing to treatment refractoriness. The Child-Pugh score/class, number of tumors, infiltrative radiological type, and recurrence were significant factors. Focusing on recurrence as a predictor, median time to untreatable progression (TTUP) was 17.2 months in the recurrence subgroup whereas 35.5 months in the initial occurrence subgroup (HR, 2.06; 95% CI, 1.44-2.96; P = 0.001). Median TTUP decreased in cases with more later times of recurrence (3-5 recurrences, 17.3 months; ≥ 6 recurrences, 7.7 months). Recurrence, even more at later times, leads to increased treatment refractoriness. Early introduction of multidisciplinary treatment should be considered against HCC patients after multiple recurrent episodes.
目前需要根据治疗适宜性对中期肝细胞癌(HCC)进行亚分类。我们旨在确定定义局部区域(经动脉化疗栓塞(TACE)或热消融)和手术治疗抵抗的预测因素。这项多中心回顾性研究纳入了 2015 年至 2021 年间的 1167 例 HCC 患者。其中,209 例患者最初被诊断为中期 HCC。治疗抵抗定义为以下 TACE 不可治疗的进展情况:(1)1 年内肝内肿瘤增加 25%,(2)一过性恶化至 Child-Pugh 分级 C,(3)大血管侵犯或肝外转移。然后,我们分析了导致治疗抵抗的因素。Child-Pugh 评分/分级、肿瘤数量、浸润性影像学类型和复发是显著因素。聚焦于复发作为预测因素,复发亚组的不可治疗进展中位时间(TTUP)为 17.2 个月,而初始发生亚组为 35.5 个月(HR,2.06;95%CI,1.44-2.96;P = 0.001)。复发次数越多,TTUP 越短(3-5 次复发,17.3 个月;≥6 次复发,7.7 个月)。即使在更晚的时候复发也会导致治疗抵抗性增加。对于多次复发的 HCC 患者,应考虑尽早引入多学科治疗。
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