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mRECIST应答对经肝动脉化疗栓塞术治疗不可切除肝细胞癌患者预后的预测价值

韩丹丹 王哲轩 王恩鑫 夏冬东 王秋和 白苇 陈勇 韩国宏

韩丹丹, 王哲轩, 王恩鑫, 等. mRECIST应答对经肝动脉化疗栓塞术治疗不可切除肝细胞癌患者预后的预测价值[J]. 临床肝胆病杂志, 2021, 37(3): 616-620. DOI: 10.3969/j.issn.1001-5256.2021.03.022
引用本文: 韩丹丹, 王哲轩, 王恩鑫, 等. mRECIST应答对经肝动脉化疗栓塞术治疗不可切除肝细胞癌患者预后的预测价值[J]. 临床肝胆病杂志, 2021, 37(3): 616-620. DOI: 10.3969/j.issn.1001-5256.2021.03.022
HAN DD, WANG ZX, WANG EX, et al. Value of Modified Response Evaluation Criteria in Solid Tumors response in predicting the prognosis of patients with unresectable hepatocellular carcinoma patients after transarterial chemoembolization[J]. J Clin Hepatol, 2021, 37(3): 616-620. DOI: 10.3969/j.issn.1001-5256.2021.03.022
Citation: HAN DD, WANG ZX, WANG EX, et al. Value of Modified Response Evaluation Criteria in Solid Tumors response in predicting the prognosis of patients with unresectable hepatocellular carcinoma patients after transarterial chemoembolization[J]. J Clin Hepatol, 2021, 37(3): 616-620. DOI: 10.3969/j.issn.1001-5256.2021.03.022

mRECIST应答对经肝动脉化疗栓塞术治疗不可切除肝细胞癌患者预后的预测价值

DOI: 10.3969/j.issn.1001-5256.2021.03.022
详细信息
    作者简介:

    韩丹丹(1994—),女,主要从事肝动脉化疗栓塞术治疗不可切除肝癌的相关研究

    通讯作者:

    韩国宏,hangh@fmmu.edu.cn

  • 利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突,特此声明。
  • 作者贡献声明:韩丹丹负责课题设计,资料分析,撰写论文;韩丹丹、王哲轩、王恩鑫、夏冬东、王秋和、白苇参与收集数据,修改论文;韩丹丹、王哲轩、陈勇、韩国宏负责拟定写作思路,指导撰写文章并最后定稿。
  • 中图分类号: R735.7

Value of Modified Response Evaluation Criteria in Solid Tumors response in predicting the prognosis of patients with unresectable hepatocellular carcinoma patients after transarterial chemoembolization

  • 摘要:   目的  探讨实体瘤疗效评价标准(mRECIST)应答对经肝动脉化疗栓塞术(TACE)治疗的不可切除肝细胞癌的预后价值。  方法  回顾性纳入2010年1月—2014年12月在空军军医大学第一附属医院消化介入科行TACE治疗连续的不可切除肝细胞癌患者190例。应用mRECIST标准评估TACE术后影像学应答,将肿瘤完全缓解(CR)和部分缓解(PR)患者定义为有应答组(n=89),将疾病进展(PD)和疾病稳定(SD)定义为无应答组(n=101)。采用Kaplan-Meier法计算中位生存时间,log-rank检验进行组间比较。利用Cox回归进行预后影响因素分析。  结果  根据mRECIST标准,CR、PR、SD和PD的患者分别有39(20.5%)例、50(26.3%)例、67(35.3%)例和34(17.9%)例。总人群的mRECIST客观应答率为46.8%。应答组的生存期明显高于无应答组,中位生存时间分别为29.9(95%CI:25.0~34.8)个月和7.5(95%CI:5.7~9.3)个月(P<0.001)。多因素分析结果显示,mRECIST应答(HR=2.02, P<0.001)、乙型肝炎(HR=4.03, P<0.001)和门静脉侵犯(HR=2.12, P=0.008)是影响患者生存的独立危险因素。  结论  mRECIST应答对经TACE治疗的不可切除肝细胞癌患者的预后具有一定的预测价值。
  • 图  1  Kaplan-Meier生存曲线

    注:a,总人群;b,mRECIST应答分层。

    表  1  190例患者的基线特征(n=190)

    指标 结果
    年龄(岁) 52(45~62)
    男/女(例) 155/35
    病因(乙型肝炎/非乙型肝炎, 例) 175/15
    ECOG评分(0/1, 例) 117/73
    BCLC分期(A/AB/B/C,例) 22/49/33/86
    肿瘤大小(cm,例) 8.3(5.5~11.5)
    肿瘤数目(单个/多个,例) 122/68
    门静脉侵犯(有/无,例) 41/149
    AFP(≤400/>400 ng/ml,例) 89/101
    血小板计数(×109/L) 123.5(83.8~176.3)
    国际标准化比值 1.08(1.02~1.20)
    AST (U/L) 49(32~69)
    白蛋白(g/L) 39.2(36.1~43.0)
    胆红素(μmol/L) 15.8(11.1~21.9)
    肌酐(μmol /L) 82(70~93)
    Child-Pugh评分(5/6,例) 144/46
    ALBI分级(1/2,例) 90/100
    mRECIST应答(CR/PR/SD/PD,例) 39/50/67/34
    下载: 导出CSV

    表  2  不同BCLC分期的影像学应答情况

    应答情况 A期(n=22) AB期(n=49) B期(n=33) C期(n=86)
    ORR[例(%)] 20 (90.9) 25 (51.0) 15 (45.5) 29 (33.7)
    CR[例(%)] 10 (45.5) 13 (26.5) 5 (15.2) 11 (12.8)
    PR[例(%)] 10 (45.5) 12 (24.5) 10 (30.3) 18 (20.9)
    SD[例(%)] 1 (4.5) 20 (40.8) 10 (30.3) 36 (41.9)
    PD[例(%)] 1 (4.5) 4 (8.2) 8 (24.2) 21 (24.4)
    下载: 导出CSV

    表  3  Cox单因素及多因素回归分析

    因素 单因素分析 多因素分析
    HR (95%CI) P HR (95%CI) P
    男性(Ref: 女性) 1.15 (0.77~1.74) 0.491
    年龄 0.98 (0.97~1.00) 0.012 0.99 (0.97~1.00) 0.173
    病因(Ref: 非乙肝) 2.77 (1.36~5.66) 0.005 4.03 (1.87~8.71) <0.001
    ECOG评分1分(Ref: 0分) 1.83 (1.33~2.51) <0.001 1.54 (0.73~3.23) 0.257
    肿瘤大小 1.11 (1.07~1.16) <0.001 1.05 (0.99~1.11) 0.102
    肿瘤数目 1.34 (1.17~1.52) <0.001 0.95 (0.80~1.13) 0.563
    门静脉侵犯(Ref: 无) 4.30 (2.93~6.30) <0.001 2.12 (1.22~3.68) 0.008
    Child-Pugh 6分(Ref: 5分) 1.28 (0.89~1.83) 0.176
    ALBI 2级(Ref: 1级) 1.38 (1.01~1.90) 0.046 1.40 (1.00~1.97) 0.054
    AFP (Ref: ≤400 ng/ml) 1.96 (1.42~2.70) <0.001 1.35 (0.95~1.93) 0.096
    肌酐 0.99 (0.98~1.00) 0.052 1.00 (1.00~1.00) 0.960
    白蛋白 0.97 (0.94~1.01) 0.104
    胆红素 1.02 (0.99~1.04) 0.151
    AST 1.01 (1.00~1.01) 0.001 1.00 (1.00~1.00) 0.986
    血小板计数 1.00 (1.00~1.00) 0.856
    国际标准化比值 2.23 (0.74~6.67) 0.152
    BCLC分期(Ref: BCLC A)
      AB期 1.51 (0.80~2.85) 0.206 0.95 (0.46~1.96) 0.892
      B期 2.49 (1.30~4.79) 0.006 1.73 (0.83~3.64) 0.145
      C期 3.54 (1.96~6.39) <0.001 1.18 (0.45~3.12) 0.740
    mRECIST应答情况(Ref: 应答) 2.33 (1.69~3.21) <0.001 2.02 (1.31~3.11) <0.001
    下载: 导出CSV
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  • 收稿日期:  2020-11-05
  • 修回日期:  2020-12-24
  • 刊出日期:  2021-03-16
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