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Radiologic Patterns Determine the Outcomes of Initial and Subsequent Transarterial Chemoembolization in Intermediate-Stage Hepatocellular Carcinoma.
Liver Cancer ( IF 11.6 ) Pub Date : 2023-05-15 , DOI: 10.1159/000530950 Ya-Wen Hung , I-Cheng Lee , Chen-Ta Chi , Rheun-Chuan Lee , Chien-An Liu , Nai-Chi Chiu , Hsuen-En Hwang , Yee Chao , Ming-Chih Hou , Yi-Hsiang Huang
Liver Cancer ( IF 11.6 ) Pub Date : 2023-05-15 , DOI: 10.1159/000530950 Ya-Wen Hung , I-Cheng Lee , Chen-Ta Chi , Rheun-Chuan Lee , Chien-An Liu , Nai-Chi Chiu , Hsuen-En Hwang , Yee Chao , Ming-Chih Hou , Yi-Hsiang Huang
Introduction
Outcomes of transarterial chemoembolization (TACE) for intermediate-stage hepatocellular carcinoma (HCC) are diverse because of the heterogeneity of tumor burden. Radiologic pattern is one criterion for determining whether TACE is unsuitable. However, additional evidence is required. This study determined the influence of radiologic morphology on the outcomes of initial and subsequent TACE.
Methods
From January 2007 to September 2021, 633 treatment-naive patients with HCC with intermediate-stage HCC undergoing TACE were retrospectively enrolled. Of these patients, 386 patients received repeated TACE. The radiological features of HCC were evaluated by two radiologists and classified into encapsulated nodular type, simple nodular type with extranodular growth, confluent multinodular type, and infiltrative type. The objective response rate (ORR) and survival rate after initial and subsequent TACE among various radiologic morphologies were compared.
Results
After initial TACE, encapsulated nodular type HCC had the highest ORR (58%), followed by extranodular type (45.8%), confluent multinodular type (29%), and infiltrative type (19.5%). Notably, radiologic pattern was highly associated with tumor burden. Tumor burden and radiologic morphology were significantly associated with ORR and overall survival (OS) in the multivariate analysis. In 386 patients with subsequent TACE, encapsulated nodular type HCC had the highest ORR (48.7%), followed by extranodular type (37.3%), confluent multinodular type (26.2%), and infiltrative type (10%). In the multivariate analysis, radiologic features were significant independent predictors of ORR and OS after receiving subsequent TACE.
Conclusion
Radiologic patterns determine the outcomes of initial and subsequent TACE. Systemic therapy should be considered for patients with intermediate-stage HCC with unfavorable radiologic patterns.
中文翻译:
放射学模式决定中期肝细胞癌初始和后续经动脉化疗栓塞的结果。
简介 由于肿瘤负荷的异质性,中期肝细胞癌 (HCC) 的经动脉化疗栓塞 (TACE) 的结果是多种多样的。放射学模式是确定 TACE 是否不适合的标准之一。但是,还需要额外的证据。本研究确定了放射学形态对初始和后续 TACE 结果的影响。方法回顾性纳入2007年1月至2021年9月633例初治接受TACE的中期HCC患者。在这些患者中,386 名患者接受了重复 TACE。由两名放射科医生评估HCC的放射学特征,将其分为包膜结节型、结节外生长的单纯结节型、融合型多结节型和浸润型。比较不同放射学形态的初次和后续 TACE 后的客观缓解率 (ORR) 和生存率。结果初次TACE后,包膜结节型HCC的ORR最高(58%),其次是结外型(45.8%)、融合型多结节型(29%)和浸润型(19.5%)。值得注意的是,放射学模式与肿瘤负荷高度相关。在多变量分析中,肿瘤负荷和放射学形态与 ORR 和总生存期 (OS) 显着相关。在386例随后接受TACE的患者中,包膜结节型HCC的ORR最高(48.7%),其次是结外型(37.3%)、融合型多结节型(26.2%)和浸润型(10%)。在多变量分析中,放射学特征是接受后续 TACE 后 ORR 和 OS 的显着独立预测因子。结论 放射学模式决定初始和后续 TACE 的结果。 对于放射学模式不利的中期 HCC 患者应考虑全身治疗。
更新日期:2023-05-15
中文翻译:
放射学模式决定中期肝细胞癌初始和后续经动脉化疗栓塞的结果。
简介 由于肿瘤负荷的异质性,中期肝细胞癌 (HCC) 的经动脉化疗栓塞 (TACE) 的结果是多种多样的。放射学模式是确定 TACE 是否不适合的标准之一。但是,还需要额外的证据。本研究确定了放射学形态对初始和后续 TACE 结果的影响。方法回顾性纳入2007年1月至2021年9月633例初治接受TACE的中期HCC患者。在这些患者中,386 名患者接受了重复 TACE。由两名放射科医生评估HCC的放射学特征,将其分为包膜结节型、结节外生长的单纯结节型、融合型多结节型和浸润型。比较不同放射学形态的初次和后续 TACE 后的客观缓解率 (ORR) 和生存率。结果初次TACE后,包膜结节型HCC的ORR最高(58%),其次是结外型(45.8%)、融合型多结节型(29%)和浸润型(19.5%)。值得注意的是,放射学模式与肿瘤负荷高度相关。在多变量分析中,肿瘤负荷和放射学形态与 ORR 和总生存期 (OS) 显着相关。在386例随后接受TACE的患者中,包膜结节型HCC的ORR最高(48.7%),其次是结外型(37.3%)、融合型多结节型(26.2%)和浸润型(10%)。在多变量分析中,放射学特征是接受后续 TACE 后 ORR 和 OS 的显着独立预测因子。结论 放射学模式决定初始和后续 TACE 的结果。 对于放射学模式不利的中期 HCC 患者应考虑全身治疗。