影响不可切除肝内胆管癌患者经动脉放射栓塞术后生存的因素：前瞻性 CIRT 研究的综合分析,CardioVascular and Interventional Radiology

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影响不可切除肝内胆管癌患者经动脉放射栓塞术后生存的因素：前瞻性 CIRT 研究的综合分析
CardioVascular and Interventional Radiology ( IF 2.8 ) Pub Date : 2024-02-06 , DOI: 10.1007/s00270-023-03657-x
Peter Reimer , Valérie Vilgrain , Dirk Arnold , Tugsan Balli , Rita Golfieri , Romaric Loffroy , Cristina Mosconi , Maxime Ronot , Christian Sengel , Niklaus Schaefer , Geert Maleux , Graham Munneke , Bora Peynircioglu , Bruno Sangro , Nathalie Kaufmann , Maria Urdaniz , Helena Pereira , Niels de Jong , Thomas Helmberger

目的

采用钇 90 树脂微球的经动脉放射栓塞 (TARE) 是肝内胆管癌 (ICC) 患者的一种治疗选择。然而，优化与全身治疗和患者选择相关的 TARE 时机仍然具有挑战性。我们在此对前瞻性观察性 CIRT 研究（NCT02305459 和 NCT03256994）进行综合分析，报告与 TARE 治疗 ICC 相关的有效性、安全性和预后因素。

方法

对 2015 年至 2020 年间入组的 174 名不可切除的 ICC 患者进行了综合分析。在基线时收集患者特征和治疗相关数据；每次随访时收集不良事件和事件发生时间数据（总生存期 [OS]、无进展生存期 [PFS] 和肝脏 PFS）。使用对数秩检验和多变量 Cox 比例风险模型来确定预后因素。

结果

除任何全身治疗外，接受一线 TARE 策略的患者的中位 OS 和 PFS 分别为 32.5 个月和 11.3 个月。选择单独进行一线 TARE 的患者的中位 OS 和 PFS 分别为 16.2 个月和 7.4 个月，而 TARE 作为第二线或进一步治疗的患者的中位 OS 和 PFS 分别为 12 个月和 9.3 个月 (p = 0.0028) 和 5.1 个月。和 3.5 个月（p = 0.0012）。分区模型剂量测定是更好 OS 的独立预测因子（HR 0.59 [95% CI 0.37–0.94]，p = 0.0259）。无肝外疾病、无腹水以及从诊断到治疗的时间< 6.1 个月是较长 PFS 的独立预测因素。

结论

这一综合分析表明，对于不可切除的 ICC，TARE 与任何全身治疗相结合是一种有前途的治疗选择。

证据级别：3级，前瞻性观察

图文摘要

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Factors Impacting Survival After Transarterial Radioembolization in Patients with Unresectable Intrahepatic Cholangiocarcinoma: A Combined Analysis of the Prospective CIRT Studies

Purpose

Transarterial radioembolization (TARE) with Yttrium-90 resin microspheres is a treatment option for patients with intrahepatic cholangiocarcinoma (ICC). However, optimising the timing of TARE in relation to systemic therapies and patient selection remains challenging. We report here on the effectiveness, safety, and prognostic factors associated with TARE for ICC in a combined analysis of the prospective observational CIRT studies (NCT02305459 and NCT03256994).

Methods

A combined analysis of 174 unresectable ICC patients enrolled between 2015 and 2020 was performed. Patient characteristics and treatment-related data were collected at baseline; adverse events and time-to-event data (overall survival [OS], progression-free survival [PFS] and hepatic PFS) were collected at every follow-up visit. Log-rank tests and a multivariable Cox proportional hazard model were used to identify prognostic factors.

Results

Patients receiving a first-line strategy of TARE in addition to any systemic treatment had a median OS and PFS of 32.5 months and 11.3 months. Patients selected for first-line TARE alone showed a median OS and PFS of 16.2 months and 7.4 months, whereas TARE as 2nd or further treatment-line resulted in a median OS and PFS of 12 and 9.3 months (p = 0.0028), and 5.1 and 3.5 months (p = 0.0012), respectively. Partition model dosimetry was an independent predictor for better OS (HR 0.59 [95% CI 0.37–0.94], p = 0.0259). No extrahepatic disease, no ascites, and < 6.1 months from diagnosis to treatment were independent predictors for longer PFS.