比较剂量测定模型以预测中晚期肝细胞癌患者放射性栓塞治疗的结果。

Comparison of dosimetry models to predict outcome for radioembolization in patients with intermediate to advanced hepatocellular carcinoma.

作者信息

Liu Hui-Chi, Liang Po-Chin, Yang Yung-Hsuan, Lin Shan-Yu, Hsu Yu-Uen, Wu Chih-Horng

机构信息

Department of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taiwan.

Department of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taiwan; Hepatits Research Center, National Taiwan University Hospital, Taipei, Taiwan; Center of Minimal-Invasive Interventional Radiology, Taiwan.

出版信息

J Formos Med Assoc. 2025 Jun 18. doi: 10.1016/j.jfma.2025.06.024.

DOI:10.1016/j.jfma.2025.06.024

PMID:40537332

Abstract

BACKGROUND

Yttrium-90 (Y90) radioembolization is an effective locoregional therapy for hepatocellular carcinoma (HCC). However, the radiation dose determines the result of Y-90. This study aimed to compare the outcomes of two dosimetry methods of Y-90 resin microspheres (the body surface area model [BSA] and the partition model [PM]) and determine the radiation dose to predict prognosis.

METHODS

A retrospective cohort study was conducted in a single tertiary medical center in Taiwan. Between May 2016 to September 2019, 89 patients with intermediate to advanced HCCs were treated with Y90 resin microspheres and followed up for at least six months. Clinical data, laboratory profiles, dosimetric parameters, tumor response, and prognosis were collected and compared between BSA and PM. Univariate and multivariate survival analyses were performed to investigate whether the dosimetric model impacts prognosis.

RESULTS

The median overall survival (OS) was 15.8 months. The PM had significantly better OS than the BSA model (27.8 vs. 10.8 months, p = 0.011). The disease control rate in the seventh month was 40.9 % in PM and 31.1 % in BSA. There was no difference in the non-tumor and tumor doses between the two dosimetric groups. The independent prognostic factors are dosimetric method and total tumor volume scale (TTVS). Subgroup analysis for each dosimetry model showed improved OS in patients who received tumor doses over 125Gy (p = 0.040 for PM; p = 0.037 for BSA). CONC: lusion: Y-90 radioembolization using the PM and tumor volume are associated with OS in patients with intermediate to advanced HCC.

摘要

背景

钇-90（Y90）放射性栓塞是肝细胞癌（HCC）的一种有效局部区域治疗方法。然而，辐射剂量决定了Y-90的治疗效果。本研究旨在比较Y-90树脂微球的两种剂量测定方法（体表面积模型[BSA]和分区模型[PM]）的结果，并确定预测预后的辐射剂量。

方法

在台湾一家三级医疗中心进行了一项回顾性队列研究。2016年5月至2019年9月期间，89例中晚期HCC患者接受了Y90树脂微球治疗，并随访至少6个月。收集并比较了BSA和PM之间的临床数据、实验室检查结果、剂量测定参数、肿瘤反应和预后。进行单因素和多因素生存分析，以研究剂量测定模型是否影响预后。

结果

中位总生存期（OS）为15.8个月。PM的OS明显优于BSA模型（27.8个月对10.8个月，p = 0.011）。PM组第7个月的疾病控制率为40.9%，BSA组为31.1%。两个剂量测定组之间的非肿瘤剂量和肿瘤剂量没有差异。独立预后因素为剂量测定方法和总肿瘤体积量表（TTVS）。对每个剂量测定模型的亚组分析显示，接受肿瘤剂量超过125Gy的患者OS有所改善（PM组p = 0.040；BSA组p = 0.037）。结论：使用PM和肿瘤体积的Y-90放射性栓塞与中晚期HCC患者的OS相关。