Introduction: The purpose of this study was to evaluate the treatment efficacy of transcatheter arterial chemo-embolization (TACE) for treatment-naive hepatocellular carcinoma (HCC) according to tumor location and burden. Methods: Between 2010 and 2019, consecutive patients who underwent TACE as the first treatment were enrolled. Tumors were classified into two categories based on their location, as central or peripheral tumors. Tumors in the central zone, which is within 1 cm of the main trunk or the first branch of the portal vein, were classified as central tumors, while those located in the peripheral zone were classified as peripheral tumors. Patients were grouped according to the HCC location and up-to-7 criteria. Patients with central tumors were classified into the central arm and those with only peripheral tumors were classified into the peripheral arm. Patients within and beyond the up-to-7 criteria were classified into the up-to-7 in and up-to-7 out groups, respectively. Local recurrence-free survival (LRFS) and progression-free survival (PFS) were compared per-nodule (central tumor vs. peripheral tumor) and per-patient (central arm vs. peripheral arm), respectively. The prognostic factors of LRFS and PFS were analyzed by univariate and multivariate analyses. Results: A total of 174 treatment-naive patients with 352 HCCs were retrospectively enrolled. Ninety-six patients and 130 lesions were selected by propensity score matching. Median LRFS was longer for peripheral tumors than central tumors (not reached vs. 3.3 months, p<0.001). Median PFS was: 17.1 months (8.3-24.9) in the peripheral arm up-to-7 in, 7.0 months (3.3-12.7) in the peripheral arm up-to-7 out, 8.4 months (4.0-12.6) in the central arm up-to-7 in, and 3.0 months (1.2-4.9) in the central arm up-to-7 out groups. The peripheral arm up-to-7 in group had significantly longer PFS than the other three groups (p=0.013, p=0.015, p<0.001, respectively). Multivariate analysis confirmed that the central zone and central arm were associated with high adjusted hazard ratios for tumor recurrence or death (2.87, p<0.001; 2.89, p<0.001, respectively). Conclusion: Treatment-naive HCCs in the peripheral zone had a longer LRFS and PFS following TACE compared to those in the central zone.


中文翻译：

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TACE 对于初治 HCC 的治疗效果根据中心或外周肿瘤位置的不同而不同


简介：本研究的目的是根据肿瘤位置和负荷评估经导管动脉化疗栓塞（TACE）对初治肝细胞癌（HCC）的治疗效果。 方法：2010年至2019年间，连续纳入接受TACE作为首次治疗的患者。肿瘤根据其位置分为两类：中央肿瘤或周围肿瘤。位于门静脉主干或第一分支1cm以内的中央区肿瘤称为中心型肿瘤，位于周围区的肿瘤称为周围型肿瘤。根据 HCC 位置和最多 7 条标准对患者进行分组。患有中央肿瘤的患者被分为中央组，而仅患有周围肿瘤的患者被分为外围组。符合和超出 up to 7 标准的患者分别分为 up to 7 in 组和 up to 7 out 组。分别比较每个结节（中心肿瘤与周围肿瘤）和每个患者（中心臂与周围臂）的局部无复发生存期（LRFS）和无进展生存期（PFS）。通过单因素和多因素分析来分析LRFS和PFS的预后因素。 结果：共有 174 名患有 352 个 HCC 的初治患者被回顾性纳入。通过倾向评分匹配选择了 96 名患者和 130 个病变。周围肿瘤的中位 LRFS 比中心肿瘤长（未达到 vs. 3.3 个月，p<0.001）。中位 PFS 为：外周臂至 7 英寸内为 17.1 个月 (8.3-24.9)，外周臂至 7 外内为 7.0 个月 (3.3-12.7)，中央臂为 8.4 个月 (4.0-12.6)臂最多 7 个入组，中央臂最多 7 个出组为 3.0 个月 (1.2-4.9)。组中 7 岁以内的外周组的 PFS 显着长于其他三组（分别为 p=0.013、p=0.015、p<0.001）。多变量分析证实，中心区和中心臂与肿瘤复发或死亡的高调整风险比相关（分别为2.87，p<0.001；2.89，p<0.001）。 结论：与中心区相比，周围区的初治 HCC 在 TACE 后具有更长的 LRFS 和 PFS。