在第一次化疗栓塞完全反应仍是最强大预测为肝癌有利结果

StephenW

Research Article
Complete response at first chemoembolization is still the most robust predictor for favorable outcome in hepatocellular carcinoma

    Beom Kyung Kim1, 2, Seung Up Kim1, 2, , , Kyung Ah Kim5, Yong Eun Chung3, Myeong-Jin Kim3, Mi-Suk Park3, Jun Yong Park1, 2, Do Young Kim1, 2, Sang Hoon Ahn1, 2, 4, Man Deuk Kim3, Sung Il Park3, Jong Yoon Won3, Do Yun Lee3, Kwang-Hyub Han1, 2, 4


Backgrounds & Aims

The aim of this study is to evaluate the prognostic significances of not only the initial and the best response during repeated transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC), but if eligible, also the time point of achieving treatment responses.
Methods

Three hundred and fourteen treatment-naïve patients with well-preserved liver function undergoing TACE were recruited. Treatment responses were assessed using modified Response Evaluation Criteria in Solid Tumors. Overall survival (OS) was analyzed using Kaplan–Meier methods, and Cox regression analysis was performed for multivariate analysis.
Results

After adjusting other variables, objective response (complete response [CR] and partial response [PR]) as the initial response (adjusted hazard ratio [HR] 0.410) and the best response (adjusted HR 0.335) had independent prognostic significances for OS, respectively (both p <0.001). Objective responders as the initial response had the longest OS, followed by patients who subsequently achieved objective response after at least two sessions and those who did not achieve objective response during treatment course eventually (52.6, 27.0, and 10.8 months, respectively; log-rank test, p <0.001). Likewise, patients with CR as the initial response had the longest OS, followed by those who subsequently achieved CR after at least two sessions and those who achieved PR as the best response (70.2, 40.6, and 23.0 months, respectively; log-rank test, p <0.001). Large (>5 cm) and multiple (⩾4) tumors were independently associated with failure to achieve CR after the initial TACE (both p <0.05).
Conclusion

Both the initial and the best response predicts OS effectively. However, achievement of treatment response at an early time point is still the most robust predictor for favorable outcomes.
Abbreviations

    HCC, hepatocellular carcinoma; TACE, transarterial chemoembolization; OS, overall survival; EASL, European Association for the Study of the Liver; mRECIST, modified Response Evaluation Criteria in Solid Tumors; CT, computed tomography; CR, complete response; PR, partial response; PD, progressive disease; SD, stable disease; HR, hazard ratio; IQR, interquartile range; AFP, α-fetoprotein; MELD, model for end-stage liver disease; AUROC, area under the receiver-operating characteristic curve; OR, odds ratio

Keywords

    Hepatocellular carcinoma; Chemoembolization; Initial response; Best response; Prognosis

    Corresponding author. Address: Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120–752, Republic of Korea. Tel.: +82 2 2228 1982; fax: +82 2 393 6884.

Copyright © 2015 European Association for the Study of the Liver. Published by Elsevier Ireland Ltd. All rights reserved.

StephenW

研究论文
在第一次化疗栓塞完全反应仍是最强大的预测为肝癌有利的结果

    范庆Kim1，2，升最多Kim1，2，，，阿炅Kim5，永恩Chung3，明洞金Kim3，米硕Park3，君永Park1，2，做年轻Kim1，2，桑勋Ahn1，2， 4，男人Deuk Kim3，宋伊尔Park3，钟尹Won3，运做Lee3，KWANG-Hyub Han1，2，4


背景与目的

本研究的目的是评价不仅在初始和在重复化学栓塞（TACE）为肝细胞癌（HCC）的最佳响应的预后意义，但如果符合条件，也实现治疗反应的时间点。
方法

三一四初治患者的保存完好的肝功能进行TACE被招募。治疗反应用修改疗效评价标准实体瘤评估。进行多因素分析总生存率采用Kaplan-Meier法（OS）进行了分析，Cox回归分析。
结果

调整其他变量，如最初的反应客观反应（完全缓解[CR]和部分响应[PR]）（调整后的危险比[HR] 0.410）和最好的回应（调整HR 0.335）后，有独立的预后意义的操作系统，分别（均P <0.001）。客观的反应作为最初的反应具有最长的操作系统，其次是病人谁随后至少两个会议及随后取得了客观的反应谁没有达到治疗的过程中，客观缓解最终（52.6，27.0和10.8个月分别对数秩检验，P <0.001）。同样地，患者的CR作为初始响应具有最长的OS，其次是谁随后至少两个会话后获得CR和那些谁取得的PR作为最佳响应（70.2，40.6，23.0个月分别; log-rank检验，P <0.001）。大（> 5厘米）和多个（⩾4）肿瘤独立与失败的初始TACE（均为P <0.05）后获得CR相关联。
结论

既有效的初始和最佳响应预测的操作系统。然而，成绩治疗反应在早期的时间点仍然是最强大的预测为有利的结果。
缩写

    肝癌，肝癌; TACE，肝动脉栓塞化疗; OS，总生存期; EASL，欧洲协会为肝脏的研究; mRECIST，实体瘤修改疗效评价标准; CT，计算机断层扫描; CR，完全缓解; PR，部分响应; PD，疾病进展; SD，病情稳定; HR，风险比; IQR，四分位范围; AFP，α胎蛋白; MELD，型号为终末期肝病; AUROC，接收者操作特征曲线下面积;或者，比值比

关键词

    肝癌;化疗栓塞;最初的反应;最好的回应;预测

    通讯作者。地址：内科，医学延世大学，延世50-1-RO，西大门区，首尔120-752，韩国系。电话：+82 2 2228 1982;传真：+82 2 393 6884。

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