肿瘤生长率对经导管动脉化疗栓塞治疗巨大肝细胞癌患者的预后评估价值

摘要/Abstract

摘要： 目的探讨肿瘤生长率对经导管动脉化疗栓塞(transcatheter arterial chemoembolization, TACE)初治的巨大肝细胞癌(hepatocellular carcinoma, HCC)患者预后价值。方法回顾性分析2016年1月至2020年3月在联勤保障部队第909医院接受TACE治疗的98例巨大HCC患者临床资料。收集人口统计学特征、肿瘤学特征和血清学标志物。使用X-tile软件计算肿瘤生长率对患者OS分组的最佳阈值。采用Kaplan-Meier法分析不同肿瘤生长率患者TACE治疗后3年内OS差异,组间差异用Log-rank检验。Cox回归分析影响患者OS的因素。结果肿瘤生长率预测患者3年生存时间的最佳截止值为-11.7%/月,根据肿瘤生长率截断值,分为低肿瘤生长率组(n=52)和高肿瘤生长率组(n=46)。Kaplan-Meier分析显示,低肿瘤生长率组的OS优于高肿瘤生长率组(χ²=7.120,P=0.008)。多因素Cox回归分析显示高肿瘤生长率(HR=2.153,P=0.006)、存在PVTT(HR=1.942,P=0.006)是影响巨大HCC患者TACE治疗后OS的独立危险因素,后续联合治疗(HR=0.532,P=0.026)是保护因素。有57例(58.16%)进行了后续治疗。低肿瘤生长率组是否接受联合治疗对HCC患者的OS无显著影响(P=0.477)。而高肿瘤生长率组TACE后联合治疗者的OS优于未联合治疗者(χ²=4.312,P=0.038)。结论肿瘤生长率对接受TACE的巨大HCC患者预后具有一定评估价值,高肿瘤生长率患者预后相对较差,但在TACE后的联合治疗中获益更多。

关键词: 巨大肝细胞癌, 肿瘤生长率, 经导管动脉化疗栓塞, 预后

Abstract: Objective To investigate the prognostic implications of tumor growth rate in patients presenting with huge hepatocellular carcinoma (HCC) initially treated with transcatheter arterial chemoembolization (TACE). Methods The clinical records of patients with huge HCC who underwent TACE treatment at our institution between January 2016 and March 2020 were retrospectively examined. This study involved the collection of demographic, oncological, and serological parameters. The X-tile software was utilized to determine the optimal tumor growth rate threshold for stratifying overal survival(OS) among the cohort. Survival discrepancies based on varing tumor growth rates within 3 years post-TACE were assessed using the Kaplan-Meier method, with intergroup differences evaluated via the Log-rank test. Additionally, A Cox proportional hazards regression model was employed to elucidate factors influencing patient OS. Results The dtermined optimal cutoff value for prognosticating the 3-year survival of patients based on with tumor growth rate was -11.7% per month. Ptiantes were stratified into a low tumor growth rate group(n=52) and a high tumor growth rate group (n=46) according to this threshold,. Kaplan-Meier analysis revealed superior OS in the low tumor growth rate group compared to the high tumor growth rate group(χ²=7.120,P=0.008). The multivariate Cox proportional hazards regression model identified a high tumor growth rate (≥-11.7%/month) (HR=2.153, P=0.006) and the presence of porta vein tumor thrombosis(PVTT) (HR=1.942, P=0.006) as independent predictors of diminished OS post-TACE in patients with huge HCC. Conversely subsequent combination therapy emerged as a protective factor(HR=0.532, P=0.026). Of all patients, 57 (58.16%) received follow-up therapy. For the low tumor growth rate group, combination therapy did not significantly affect OS(P=0.477). Yet, for the high tumor growth rate cohort, post-TACE OS was notably improved in those receiving subsequent combination therapy compared to those without(χ²=4.312,P=0.038). Conclusion Tumor growth rate hodls a discernible prognostic value for patients with huge HCC undergoing TACE as the initial treatment. Those exhibiting a higher tumor growth rate tend to have a relatively poorer prognosis. Notably, patients with a rapid tumor growth rate derive greater benefit from subsequent combination therapy following TACE.

Key words: Huge hepatocellular carcinoma, Tumor growth rate, Transcatheter arterial chemoembolization, prognosis

陈宗杰, 彭新建, 王瑜林, 胡添松. 肿瘤生长率对经导管动脉化疗栓塞治疗巨大肝细胞癌患者的预后评估价值[J]. 肝脏, 2024, 29(1): 85-90.

CHEN Zong-jie, PENG Xin-jian, WANG Yu-lin, HU Tian-song. Assessing the prognostic significance of tumor growth rate in patients with huge hepatocellular carcinoma undergoing transcatheter arterial chemoembolization[J]. Chinese Hepatolgy, 2024, 29(1): 85-90.

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