He Zijun, Zhang Xueying, Zhang Yucong, Kong Jian
The Second Clinical Medical College, Jinan University, Shenzhen, China.
Department of Radiation Oncology, Shenzhen People's Hospital (Second Clinical Medical College of Jinan University, First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China.
Front Pharmacol. 2024 Jul 23;15:1413696. doi: 10.3389/fphar.2024.1413696. eCollection 2024.
In this retrospective cohort study, independent risk factors that influence untreatable progression (UP) and time to UP (TTUP) in patients with hepatocellular carcinoma (HCC) after locoregional interventional therapy were examined. The effects of initial response and best response on UP occurrence and TTUP after locoregional interventional therapy were evaluated.
Data were collected from HCC patients who were initially treated with the drug-eluting beads-transcatheter arterial chemoembolization (DEB-TACE) procedure at our hospital from January 2017 to December 2022. Modified response evaluation criteria in solid tumors (m-RECIST) was used to evaluate the radiologic response of tumors. Logistic regression analysis was used to analyze the risk factors for UP in patients, and Cox regression analysis was used to discover independent variables that influenced TTUP.
A total of 93 patients who initially underwent the DEB-TACE procedure were included. Subsequent to initial treatment, 50 patients continued with DEB-TACE treatment, while 43 received DEB-TACE and sequential thermal ablation treatment. The probability of developing UP was 82.8% (n = 77). Furthermore, 49 (52.7%) patients achieved an initial response, and 70 (75.3%) achieved the best response. Multivariate logistic regression analysis confirmed three independent risk factors of UP, namely, age (odds ratio [OR]: 0.950, = 0.044); initial response (OR: 0.177, = 0.020); and treatment regimen (OR: 7.133, = 0.007). Multivariate Cox regression found that total bilirubin (hazard ratio [HR]: 1.029, = 0.002), tumor distribution (HR: 1.752, = 0.034), Subjective Angiographic Chemoembolization Endpoint (SACE) classification (HR: 0.668, = 0.043), number of tumors (HR: 1.130, = 0.004), initial response (HR: 0.539, = 0.019), and treatment regimen (HR: 4.615, < 0.001) were independent variables that influenced TTUP.
Age, initial response, and treatment regimen significantly affected the occurrence of UP in HCC patients. Initial response, SACE classification, treatment regimen, total bilirubin, number of tumors, and tumor distribution were significantly correlated with TTUP. The initial response following locoregional interventional therapy had greater effects on UP occurrence and TTUP than the best response.
在这项回顾性队列研究中，研究了影响肝细胞癌（HCC）患者在局部区域介入治疗后不可治疗进展（UP）及进展时间（TTUP）的独立危险因素。评估了初始反应和最佳反应对局部区域介入治疗后UP发生及TTUP的影响。
收集2017年1月至2022年12月在我院最初接受载药微球经动脉化疗栓塞术（DEB-TACE）治疗的HCC患者的数据。采用实体瘤改良反应评估标准（m-RECIST）评估肿瘤的放射学反应。采用逻辑回归分析分析患者发生UP的危险因素，采用Cox回归分析发现影响TTUP的独立变量。
共纳入93例最初接受DEB-TACE治疗的患者。初始治疗后，50例患者继续接受DEB-TACE治疗，43例接受DEB-TACE及序贯热消融治疗。发生UP的概率为82.8%（n = 77）。此外，49例（52.7%）患者获得初始反应，70例（75.3%）患者获得最佳反应。多因素逻辑回归分析确认了UP的三个独立危险因素，即年龄（比值比[OR]：0.950，P = 0.044）；初始反应（OR：0.177，P = 0.020）；以及治疗方案（OR：7.133，P = 0.007）。多因素Cox回归分析发现总胆红素（风险比[HR]：1.029，P = 0.002）、肿瘤分布（HR：1.752，P = 0.034）、主观血管造影化疗栓塞终点（SACE）分类（HR：0.668，P = 0.043）、肿瘤数量（HR：1.130，P = 0.004）、初始反应（HR：0.539，P = 0.019）和治疗方案（HR：4.615，P < 0.001）是影响TTUP的独立变量。
年龄、初始反应和治疗方案显著影响HCC患者UP的发生。初始反应、SACE分类、治疗方案、总胆红素、肿瘤数量和肿瘤分布与TTUP显著相关。局部区域介入治疗后的初始反应对UP发生及TTUP的影响大于最佳反应。
