肝细胞癌初次药物洗脱微球-经导管动脉化疗栓塞术后肿瘤客观反应临床预测因素分析  

Analysis of the clinical predictors for the objective response in patients with hepatocellular carcinoma after initial drug-eluting beads-transcatheter arterial chemoembolization

作　　者：张雪莹 孔健[1] ZHANG Xueying;KONG Jian(The Second Clinical Medical College,Jinan University,Shenzhen,Guangdong Province 518020,China)

机构地区：[1]暨南大学第二临床医学院,广东深圳518020

出　　处：《介入放射学杂志》2023年第8期786-791,共6页Journal of Interventional Radiology

基　　金：北京医学奖励基金(YXJL-2020-0972-1220)。

摘　　要：目的 探讨影响肝细胞癌(HCC)患者初次药物洗脱微球-经导管动脉化疗栓塞术(DEBTACE)后肿瘤客观反应(OR)的临床预测因素。方法 回顾性分析2017年1月至2021年9月在深圳市人民医院接受DEB-TACE治疗的103例HCC患者临床基线资料及术后首次随访影像学资料。根据改良实体瘤疗效评价标准(mRECIST)评价肿瘤影像学反应。采用单因素、多因素logistic回归分析患者初始OR和完全反应(CR)的临床预测因素。结果 103例患者术后OR比率为65%(n=67),CR比率为18.4%(n=19)。单因素logistic分析结果显示,病因、ALBI分级、血小板计数、肿瘤分布、血管湖、假包膜、强化类型、SACE分级、肿瘤数目、肿瘤最大径、6-and-12肿瘤负荷与初次DEB-TACE后OR密切相关;多因素分析显示,1+2型强化(OR=13.260,95%CI=1.418~123.967,P=0.023)、出现血管湖(OR=10.506,95%CI=1.187~93.000,P=0.035)、存在假包膜(OR=8.064,95%CI=1.483~43.859,P=0.016)、6-and-12肿瘤负荷(OR=3.941,95%CI=1.395~11.128,P=0.010)是初始OR的独立预测因素。单因素分析显示,BCLC分期、血小板计数、肿瘤分布、血管湖、强化类型、肿瘤最大径、6-and-12肿瘤负荷与术后初始CR密切相关;多因素分析显示,1+2型强化(OR=7.586,95%CI=1.351~42.604,P=0.021)、单叶肿瘤(OR=7.181,95%CI=1.171~44.136,P=0.033)、6-and-12肿瘤负荷(OR=7.104,95%CI=1.169~43.159,P=0.033)是初始CR的独立预测因素。结论 1+2型强化、出现血管湖、存在假包膜及肿瘤负荷≤6、>6且≤12患者初次DEB-TACE后更易OR;1+2型强化、单叶肿瘤及肿瘤负荷≤6患者更倾向CR。Objective To investigate the clinical predictors for the objective response(OR)in patients with hepatocellular carcinoma(HCC)after receiving initial drug-eluting beads-transcatheter arterial chemoembolization(DEB-TACE).Methods The clinical baseline data and the postoperative first time fllow-up imaging materials of 103 patients with HCC,who received DEB-TACE between January 2017 and September 2021 at the Shenzhen People's Hospital of China,were retrospectively analyzed.The modified Response Evaluation Criteria in Solid Tumors(mRECIST)criterion was used to evaluate the imaging response of tumor.Univariate analysis and multivariate logistic regression analysis were used to analyze the clinical predictors for the initial OR and complete response(CR)of patients.Results In the 103 HCC patients the postoperative OR rate was 65%(n=67)and CR rate was 18.4%(n=19).The univariate logistic analysis indicated that the cause of disease,ALBI grade,platelet count,tumor distribution,vascular lake,pseudocapsule,enhancement type,SACE grade,number of tumor lesions,maximum tumor diameter,6-and-12 criteria were closely associated with OR after initial DEB-TACE,and multivariate logistic regression analysis showed that type 1+2 enhancement(0R=13.260,95%CI-1.418-123.967,P-0.023),presence of vascular lake(0R=10.506,95%CI=1.187-93.000,P=0.035),presence of pseudocapsule(0R=8.064,95%CI=1.483-43.859,P=0.016),6-and-12 criteria(0R=3.941,95%CI=1.395-11.128,P=0.010)were the independent predictors for OR after initial DEB-TACE.Univariate analysis revealed that BCLC stage,platelet count,tumor distribution,vascular lake,enhancement type,maximum tumor diameter,and 6-and-12 criteria were closely related to postoperative CR;and multivariate analysis showed that type 1+2 enhancement(OR-7.586,95%CI-1.351-42.604,P-0.021),unilobar(0R=7.181,95%CI-1.171-44.136,P-0.033),and 6-and-12 criteria(OR=7.104,95%CI-1.169-43.159,P-0.033)were the independent predictors for CR.Conclusion In patients,whose imaging examinations demonstrate type 1+2 enhancement,presence of

关 键 词：药物洗脱微球-经导管动脉化疗栓塞术 肝细胞癌 初始反应 6-and-12肿瘤负荷 同质性强化 血管湖 

分 类 号：R735.7[医药卫生—肿瘤]