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

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。

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

Objective To investigate the association of Modified Response Evaluation Criteria in Solid Tumors(mRECIST)response with the prognosis of patients with unresectable hepatocellular carcinoma(HCC)after transarterial embolization(TACE).Methods A retrospective analysis was performed for the clinical data of 190 patients with unresectable HCC who were consecutively admitted to Department of Liver Disease and Digestive Interventional Radiology,The First Affiliated Hospital of Air Force Medical University,and treated with TACE from January 2010 to December 2014.The mRECIST criteria were used to evaluate imaging response after TACE;the patients with complete response(CR)or partial response(PR)were enrolled as response group(n=89),and those with progressive disease(PD)or stable disease(SD)were enrolled as non-response group(n=101).The Kaplan-Meier method was used to calculate median survival time,and the log-rank test was used for comparison between groups;the Cox regression model was used to identify the influencing factors for prognosis.Results According to the mRECIST criteria,39 patients(20.5%)achieved CR,50(26.3%)achieved PR,67(35.3%)had SD,and 34(17.9%)had PD.The objective response rate based on mRECIST was 46.8%for the whole population.The response group had a significantly longer survival time than the non-response group,and the median survival time was 29.9(95%confidence intervalCI]:25.0-34.8)months for the response group and 7.5(95%CI:5.7-9.3)months for the non-response group(P<0.001).The multivariate analysis showed that mRECIST response(hazard ratioHR]=2.02,P<0.001),hepatitis B(HR=4.03,P<0.001),and portal invasion(HR=2.12,P=0.008)were independent risk factors for survival.Conclusion The mRECIST response has a certain value in predicting the prognosis of patients with unresectable HCC after TACE.