Schmidt Robin, Rueger Christopher, Xu Han, He Yubei, Yilmaz Emine Yaren, Heidemann Luisa, Sulejmani Ornela, Liu Yu, Noack Lasse, Hesse Friederike, Ruppel Richard, Abosabie Sara A, Hamm Charlie Alexander, Penzkofer Tobias, Gebauer Bernhard, Savic Lynn Jeanette
Department of Radiology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Experimental Clinical Research Center (ECRC) at Charité-Universitätsmedizin Berlin and Max-Delbrück-Centrum für Molekulare Medizin (MDC), Robert-Rössle-Straße 10, 13125 Berlin, Germany.
Cancers (Basel). 2025 Apr 9;17(8):1275. doi: 10.3390/cancers17081275.
The aim of this study was to investigate the prognostic value of established response assessment tools for hepatocellular carcinoma (HCC) treated with high-dose-rate interstitial brachytherapy (iBT) alone or with transarterial chemoembolization (cTACE). (Non-)responders were categorized using size-based RECIST 1.1 and WHO criteria, enhancement-based mRECIST and EASL criteria, and the LI-RADS Treatment Response Algorithm (LR-TRA). The outcomes were the overall survival (OS), progression-free survival (PFS), and time to progression (TTP). The statistics used included Fisher's exact test, a -test, the Mann-Whitney-U test, and a Kaplan-Meier analysis. The median OS, PFS, and TTP were higher in patients following iBT (26.3, 9.1, and 13.0 months) than following cTACE/iBT (23.3, 7.6, and 9.2 months). The enhancement-based criteria identified more responders and predicted PFS and TTP better compared to the size-based criteria. At two months, the cTACE/iBT responders showed improved PFS (mRECIST and EASL: 11.3 vs. 2.3 and 11.0 vs. 2.3, < 0.01) and TTP (mRECIST and EASL: 11.9 vs. 2.4 months, < 0.01) by the enhancement-based criteria. An EASL assessment at five months predicted improved survival following both cTACE/iBT (PFS: 11.9 vs. 5.1 months, = 0.03; TTP: 12.4 vs. 5.0, < 0.01) and iBT (11.1 vs. 5.1 months, = 0.04; 13.0 vs. 5.3, < 0.01). The LR-TRA showed OS benefits at five months for cTACE/iBT responders. Size-based criteria were not prognostic. Extending follow-up post-iBT or post-iBT/cTACE may improve responder stratification and prognostication.
本研究的目的是探讨既定的反应评估工具对单独接受高剂量率组织间近距离放疗（iBT）或联合经动脉化疗栓塞术（cTACE）治疗的肝细胞癌（HCC）的预后价值。使用基于大小的RECIST 1.1和WHO标准、基于强化的mRECIST和EASL标准以及LI-RADS治疗反应算法（LR-TRA）对（无）反应者进行分类。观察指标为总生存期（OS）、无进展生存期（PFS）和疾病进展时间（TTP）。所采用的统计学方法包括Fisher精确检验、t检验、Mann-Whitney-U检验和Kaplan-Meier分析。接受iBT治疗的患者的中位OS、PFS和TTP（分别为26.3、9.1和13.0个月）高于接受cTACE/iBT治疗的患者（分别为23.3、7.6和9.2个月）。与基于大小的标准相比，基于强化的标准识别出更多反应者，并且对PFS和TTP的预测更好。在两个月时，根据基于强化的标准，cTACE/iBT反应者的PFS有所改善（mRECIST和EASL：分别为11.3 vs. 2.3以及11.0 vs. 2.3，P<0.01）和TTP（mRECIST和EASL：11.9 vs. 2.4个月，P<0.01）。在五个月时进行的EASL评估预测，cTACE/iBT（PFS：11.9 vs. 5.1个月，P = 0.03；TTP：12.4 vs. 5.0，P<0.01）和iBT（11.1 vs. 5.1个月，P = 0.04；13.0 vs. 5.3，P<0.01）治疗后的生存期均有所改善。LR-TRA显示，cTACE/iBT反应者在五个月时有OS获益。基于大小的标准无预后价值。延长iBT后或iBT/cTACE后的随访时间可能会改善反应者分层和预后评估。
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