病毒性肝炎相关的肝细胞癌结果与钇-90放射性栓塞

StephenW

J Gastrointest Oncol. 2018 Jun;9(3):546-552. doi: 10.21037/jgo.2018.03.04.
Viral hepatitis associated hepatocellular carcinoma outcomes with yttrium-90 radioembolization.
Frakes JM1, Abuodeh YA1, Naghavi AO1, Echevarria MI1, Shridhar R2, Friedman M3, Kim R3, El-Haddad G4, Kis B4, Biebel B4, Sweeney J4, Choi J4, Anaya D3, Giuliano AR5, Hoffe SE1.
Author information

1
    Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
2
    Department of Radiation Oncology, Florida Hospital Cancer Institute, Orlando, FL, USA.
3
    Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
4
    Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
5
    Center of Infection Research Center, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.

Abstract
Background:

Viral associated (VA) malignancies have recently been correlated with improved outcomes. We sought to evaluate outcomes of patients with hepatocellular carcinoma (HCC) with and without viral hepatitis (hepatitis B and C) treated with lobar yttrium-90 radioembolization (Y-90 RE).
Methods:

After IRB approval, an institutional database of patients with HCC who received RE between 2009-2014 was queried and 99 patients were identified that received a total of 122 lobar RE. Charts were reviewed to capture previous treatments, viral hepatitis status, α-fetoprotein values (AFP), Child-Pugh class (CP), albumin-bilirubin score (ALBI), portal vein thrombosis (PVT), volumes treated and doses delivered. Comparison was made with Chi-square and Mann-Whitney U test. Intrahepatic control (IHC), extrahepatic control (EHC), progression free survival (PFS), and overall survival (OS) were calculated according to the Kaplan-Meier method stratified by cause of underlying liver disease (viral vs. non-viral) and survival differences were assessed via the log-rank test. Hazard ratios were calculated using Cox regression.
Results:

Median follow up for VA HCC and non-VA (NVA) HCC patients was 10.9 months (range, 0.8-46.7 months) and 11.8 months (range, 1.1-62.8 months), respectively. Patients with VA HCC (n=44) were younger (P<0.001) and had smaller pretreatment liver volumes (P<0.001); however, there was no difference with respect to gender, pre-treatment AFP, CP, ALBI, PVT, extrahepatic disease, previous treatment, or dose delivered. Median doses for VA and NVA HCC patients were 129.5 Gy (range, 90-215.8 Gy) and 131 Gy (range, 100.9-265 Gy), respectively (P=0.75). One year IHC showed a strong trend to better control for VA HCC at 67% versus 34% for NVA HCC (P=0.067) but 1 year EHC was significantly worse at 63% for VA HCC versus 86% for NVA HCC (P=0.027). There were no significant differences in survival, with a 1-year PFS of 45% for VA HCC versus 31% for NVA HCC (P=0.56) and 1 year OS of 46% versus 55% (P=0.55). Patients that received salvage treatments, CP A, no PVT, and those without extrahepatic disease had improved OS.
Conclusions:

Patients with VA HCC had a trend to improved IHC and significantly worse EHC. Prospective investigation of novel systemic therapies following Y-90 RE in patients with VA HCC is warranted to potentially further extend survival in VA HCC patients by addressing extra-hepatic disease.
KEYWORDS:

Viral hepatitis; hepatocellular carcinoma (HCC); radioembolization

PMID:
    29998020
PMCID:
    PMC6006034
DOI:
    10.21037/jgo.2018.03.04

StephenW

J Gastrointest Oncol。 2018年6月; 9（3）：546-552。 doi：10.21037 / jgo.2018.03.04。
病毒性肝炎相关的肝细胞癌结果与钇-90放射性栓塞。
Frakes JM1，Abuodeh YA1，Naghavi AO1，Echevarria MI1，Shridhar R2，Friedman M3，Kim R3，El-Haddad G4，Kis B4，Biebel B4，Sweeney J4，Choi J4，Anaya D3，Giuliano AR5，Hoffe SE1。
作者信息

1
    美国佛罗里达州坦帕市H. Lee Moffitt癌症中心和研究所放射肿瘤科。
2
    佛罗里达州医院癌症研究所放射肿瘤科，美国佛罗里达州奥兰多市。
3
    美国佛罗里达州坦帕市H. Lee Moffitt癌症中心和研究所胃肠肿瘤科。
4
    美国佛罗里达州坦帕市H. Lee Moffitt癌症中心和研究所诊断成像和介入放射科。
五
    美国佛罗里达州坦帕市H. Lee Moffitt癌症中心和研究所感染研究中心。

抽象
背景：

最近，病毒相关（VA）恶性肿瘤与改善的结果相关。我们试图评估使用肺叶钇-90放射性栓塞（Y-90RE）治疗的有或没有病毒性肝炎（乙型和丙型肝炎）的肝细胞癌（HCC）患者的结果。
方法：

在IRB批准后，查询了2009 - 2014年间接受RE的HCC患者的机构数据库，并确定了99名患者，共收到122个肺叶RE。检查图表以捕获先前的治疗，病毒性肝炎状态，甲胎蛋白值（AFP），Child-Pugh分级（CP），白蛋白 - 胆红素评分（ALBI），门静脉血栓形成（PVT），治疗量和递送剂量。与Chi-square和Mann-Whitney U检验进行比较。肝内控制（IHC），肝外控制（EHC），无进展生存期（PFS）和总生存期（OS）根据潜在肝病（病毒与非病毒）原因分层的Kaplan-Meier方法计算，通过对数秩检验评估存活差异。使用Cox回归计算危险比。
结果：

VA HCC和非VA（NVA）HCC患者的中位随访分别为10.9个月（范围，0.8-46.7个月）和11.8个月（范围，1.1-62.8个月）。 VA HCC患者（n = 44）年龄较小（P <0.001），治疗前肝脏体积较小（P <0.001）;然而，在性别，治疗前AFP，CP，ALBI，PVT，肝外疾病，既往治疗或递送剂量方面没有差异。 VA和NVA HCC患者的中位剂量分别为129.5 Gy（范围，90-215.8 Gy）和131 Gy（范围，100.9-265 Gy）（P = 0.75）。一年的IHC显示出更好的控制VA HCC的趋势为67％而NVA HCC为34％（P = 0.067），但1年EHC显着恶化，VA HCC为63％，而NVA HCC为86％（P = 0.027） ）。存活率无显着差异，VA HCC的1年PFS为45％，而NVA HCC为1％PFS（P = 0.56），1年OS为46％对55％（P = 0.55）。接受挽救治疗，CP A，无PVT和无肝外疾病的患者OS均有改善。
结论：

VA HCC患者有改善IHC的趋势和显着更差的EHC。对VA HCC患者中Y-90 RE后新型全身治疗的前瞻性研究有必要通过解决肝外疾病来进一步延长VA HCC患者的生存期。
关键词：

病毒性肝炎;肝细胞癌（HCC）; radioembolization

结论：
    29998020
PMCID：
    PMC6006034
DOI：
    10.21037 / jgo.2018.03.04