中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 37 Issue 3
Mar.  2021
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2021  >  37(3): 611-615

Clinical effect of transcatheter arterial chemoembolization in treatment of patients with hepatocellular carcinoma and portal vein tumor thrombus and an analysis of prognostic evaluation models

DOI: 10.3969/j.issn.1001-5256.2021.03.021

  • Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi'an 710032, China

  • Received Date: 2020-11-10
  • Accepted Date: 2020-12-08
  • Published Date: 2021-03-20
    Abstract
  •   Objective  To investigate the clinical effect of transcatheter arterial chemoembolization (TACE) in the treatment of patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus and the value of existing prognostic evaluation models for HCC.  Methods  Screening was performed for HCC patients who underwent TACE in 24 tertiary hospitals in China from January 2010 to May 2016, and finally 266 HCC patients with portal vein tumor thrombus were included for retrospective analysis. The Kaplan-Meier method was used to plot survival curves and the log-rank test was used for comparison; a Cox regression analysis was used to perform univariate and multivariate analyses and establish a Cox regression model; area under the ROC curve (AUC) and C-index were calculated for HAP score, mHAP score, mHAP2 score, mHAP3 score, and 6&12 criteria to compare their prediction performance.  Results  The median survival time was 9.867 months for all patients, and according to Child-Pugh class, the patients with Child-Pugh class A HCC had a significantly longer median survival time than those with Child-Pugh class B HCC (10.067 months vs 5.967 months, χ2=5.181, P=0.023). The patients with alpha-fetoprotein (AFP) ≤800 ng/ml had a significantly longer median survival time than those with AFP > 800 ng/ml (13.10 months vs 8.13 months, χ2=8.643, P=0.003). The univariate analysis showed that number of tumors, tumor diameter, total bilirubin, serum albumin, alanine aminotransferase (AST), and alanine aminotransferase (ALT) were associated with the survival of patients (all P < 0.05), and the multivariate analysis showed that number of tumors (hazard ratio [HR]=1.186, 95% confidence interval [CI]: 1.058-1.329, P < 0.05) and tumor diameter (HR=1.047, 95% CI: 1.001-1.095, P < 0.05) were independent influencing factors for the survival of patients. The 1-, 2-, and 3-year AUCs of 6&12 criteria were 0.651, 0.655, and 0.641, respectively, which were higher than those of the other models; 6&12 criteria and the new model had a C-index of 0.577 and 0.579, respectively, which were higher than C-index of the other models.  Conclusion  TACE is safe and effective in HCC patients with portal vein tumor thrombus who have a low AFP level and good liver function. Tumor diameter and number of tumors provide a reliable basis for screening out the patients suitable for TACE. Among the existing prognostic evaluation models for primary liver cancer, 6&12 criteria have a better predictive capability than the other models.

     

    • FullText(HTML)
  • loading
    • References(22)
  • [1]
    TORRE LA, BRAY F, SIEGEL RL, et al. Global cancer statistics, 2012[J]. CA Cancer J Clin, 2015, 65(2): 87-108. DOI: 10.3322/caac.21262
    [2]
    KUO YH, LU SN, CHEN CL, et al. Hepatocellular carcinoma surveillance and appropriate treatment options improve survival for patients with liver cirrhosis[J]. Eur J Cancer, 2010, 46(4): 744-751. DOI: 10.1016/j.ejca.2009.12.018
    [3]
    FORNER A, REIG M, BRUIX J. Hepatocellular carcinoma[J]. Lancet, 2018, 391(10127): 1301-1314. DOI: 10.1016/S0140-6736(18)30010-2
    [4]
    PARK JW, CHEN M, COLOMBO M, et al. Global patterns of hepatocellular carcinoma management from diagnosis to death: the BRIDGE Study[J]. Liver Int, 2015, 35(9): 2155-2166. DOI: 10.1111/liv.12818
    [5]
    LLOVET JM, REAL MI, MONTANA X, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: A randomised controlled trial[J]. Lancet, 2002, 359(9319): 1734-1739. DOI: 10.1016/S0140-6736(02)08649-X
    [6]
    LLOVET JM, BRUIX J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival[J]. Hepatology, 2003, 37(2): 429-442. DOI: 10.1053/jhep.2003.50047
    [7]
    LO CM, NGAN H, TSO WK, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma[J]. Hepatology, 2002, 35(5): 1164-1171. DOI: 10.1053/jhep.2002.33156
    [8]
    KADALAYIL L, BENINI R, PALLAN L, et al. A simple prognostic scoring system for patients receiving transarterial embolisation for hepatocellular cancer[J]. Ann Oncol, 2013, 24(10): 2565-2570. DOI: 10.1093/annonc/mdt247
    [9]
    PINATO DJ, ARIZUMI T, ALLARA E, et al. Validation of the hepatoma arterial embolization prognostic score in European and Asian populations and proposed modification[J]. Clin Gastroenterol Hepatol, 2015, 13(6): 1204-1208. e2. DOI: 10.1016/j.cgh.2014.11.037
    [10]
    PARK Y, KIM SU, KIM BK, et al. Addition of tumor multiplicity improves the prognostic performance of the hepatoma arterial-embolization prognostic score[J]. Liver Int, 2016, 36(1): 100-107. DOI: 10.1111/liv.12878
    [11]
    CAPPELLI A, CUCCHETTI A, CABIBBO G, et al. Refining prognosis after trans-arterial chemo-embolization for hepatocellular carcinoma[J]. Liver Int, 2016, 36(5): 729-736. DOI: 10.1111/liv.13029
    [12]
    WANG Q, XIA D, BAI W, et al. Development of a prognostic score for recommended TACE candidates with hepatocellular carcinoma: A multicentre observational study[J]. J Hepatol, 2019, 70(5): 893-903. DOI: 10.1016/j.jhep.2019.01.013
    [13]
    HEIMBACH JK, KULIK LM, FINN RS, et al. AASLD guidelines for the treatment of hepatocellular carcinoma[J]. Hepatology, 2018, 67(1): 358-380. DOI: 10.1002/hep.29086
    [14]
    STUART KE, ANAND AJ, JENKINS RL. Hepatocellular carcinoma in the United States. Prognostic features, treatment outcome, and survival[J]. Cancer, 2015, 77(11): 2217-2222. https://www.researchgate.net/publication/227770280_Hepatocellular_carcinoma_in_the_United_States_Prognostic_features_treatment_outcome_and_survival
    [15]
    MINAGAWA M, MAKUUCHI M. Treatment of hepatocellular carcinoma accompanied by portal vein tumor thrombus[J]. World J Gastroenterol, 2006, 12(47): 7561-7567. DOI: 10.3748/wjg.v12.i47.7561
    [16]
    ZHU K, CHEN J, LAI L, et al. Hepatocellular carcinoma with portal vein tumor thrombus: treatment with transarterial chemoembolization combined with sorafenib-a retrospective controlled study[J]. Radiology, 2014, 272(1): 284-293. DOI: 10.1148/radiol.14131946
    [17]
    KIM KM, KIM JH, PARK IS, et al. Reappraisal of repeated transarterial chemoembolization in the treatment of hepatocellular carcinoma with portal vein invasion[J]. J Gastroenterol Hepatol, 2009, 24(5): 806-814. DOI: 10.1111/j.1440-1746.2008.05728.x
    [18]
    NIU ZJ, MA YL, KANG P, et al. Transarterial chemoembolization compared with conservative treatment for advanced hepatocellular carcinoma with portal vein tumor thrombus: Using a new classification[J]. Med Oncol, 2012, 29(4): 2992-2997. DOI: 10.1007/s12032-011-0145-0
    [19]
    PINTER M, HUCKE F, GRAZIADEI I, et al. Advanced-stage hepatocellular carcinoma: Transarterial chemoembolization versus sorafenib[J]. Radiology, 2012, 263(2): 590-599. DOI: 10.1148/radiol.12111550
    [20]
    KUDO M, FINN RS, QIN S, et al. Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: A randomised phase 3 non-inferiority trial[J]. Lancet, 2018, 391(10126): 1163-1173. DOI: 10.1016/S0140-6736(18)30207-1
    [21]
    BRUIX J, RAOUL JL, SHERMAN M, et al. Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma: subanalyses of a phase Ⅲ trial[J]. J Hepatol, 2012, 57(4): 821-829. DOI: 10.1016/j.jhep.2012.06.014
    [22]
    BRUIX J, QIN S, MERLE P, et al. Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE): A randomised, double-blind, placebo-controlled, phase 3 trial[J]. Lancet, 2017, 389(10064): 56-66. DOI: 10.1016/S0140-6736(16)32453-9
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(2)  / Tables(3)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (654) PDF downloads(46) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return