基于影像学评价手段确定经肝动脉化疗栓塞术联合仑伐替尼治疗不可切除肝细胞癌患者疗效评估最早时间节点  

Determination of the earliest time point for efficacy evaluation of transarterial chemoembolization combined with lenvatinib in patients with unresectable hepatocellular carcinoma based on imaging evaluation methods

作　　者：祝叶静 汪檬檬 赵首捷 汪博 高源 李惠晨 刘雷 杜锡林 ZHU Ye-jing;WANG Meng-meng;ZHAO Shou-jie;WANG Bo;GAO Yuan;LI Hui-chen;LIU Lei;DU Xi-lin(Department of General Surgery,Second Affiliated Hospital of Air Force Medical University,Xi′an 710038,China;Department of Drug and Equipment,Lintong Rehabilitation and Convalescent Centre,Xi′an 710600,China;State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers,National Clinical Research Center for Digestive Diseases,Xijing Hospital of Air Force Medical University,Xi′an 710032,China;Biopharmaceutical Science,Department of Pharmacy;Department of Biochemistry and Molecular Biology,School of Basic Medicine,Air Force Medical University,Xi′an 710032,China)

机构地区：[1]空军军医大学第二附属医院普通外科,陕西西安710038 [2]联勤保障部队临潼康复疗养中心药剂科,陕西西安710600 [3]空军军医大学西京消化病医院国家消化系统疾病临床医学研究中心消化系肿瘤整合防治全国重点实验室,陕西西安710032 [4]空军军医大学药学系生物制药学教研室 [5]空军军医大学基础医学院生物化学与分子生物学教研室,陕西西安710032

出　　处：《临床军医杂志》2024年第11期1123-1128,共6页Clinical Journal of Medical Officers

基　　金：陕西省自然科学基金(2024JC-JCQH-78)。

摘　　要：目的探讨经肝动脉化疗栓塞术(TACE)联合仑伐替尼治疗不可切除的肝细胞癌(HCC)患者的影像学评价结果与生存预后的关系,寻找影像学疗效判断的最早时间节点。方法回顾性分析自2019年6月至2022年6月于空军军医大学西京消化病医院及空军军医大学第二附属医院行TACE联合仑伐替尼治疗的186例不可切除的HCC患者的临床资料。使用Cox风险比例回归模型确定患者生存预后的影响因素。根据实体肿瘤反应评估标准(RECIST)和改良的实体肿瘤疗效评估标准(mRESICT)评估患者治疗效果。使用Kendall′s tau-b检验进行影像学评价结果的一致性分析。采用Kaplan-Meier方法绘制生存曲线,采用Log-rank检验进行组间生存分析。结果RECIST标准评价客观缓解率(ORR)为17.8%(33/186),mRECIST标准评价ORR为43.0%(80/186),Kendall′s tau-b相关系数为0.506(P<0.001)。RECIST标准和mRECIST标准的疾病控制率(DCR)均为71.0%(132/186),Kendall′s tau-b相关性系数为1.000(P<0.001)。多因素Cox回归分析结果显示,白蛋白、总胆红素、RECIST/mRECIST标准DCR是患者生存预后的独立影响因素(P<0.05)。按复查时间及RECIST/mRESICT标准评价指标疾病控制情况,将4周内复查的患者分为疾病控制1组(n=23)、疾病进展1组(n=5),将4~6周复查的患者分为疾病控制2组(n=47)、疾病进展2组(n=17),将6周及以上复查的患者分为疾病控制3组(n=62)、疾病进展3组(n=32)。疾病控制1组与疾病进展1组的生存曲线无显著差异(Log-rankχ^(2)=0.114,P=0.736)。疾病控制2组与疾病进展2组的生存曲线差异显著(Log-rankχ^(2)=12.076,P=0.001);疾病控制2组和疾病进展2组1年累积存活率分别为67.1%、34.3%。疾病控制3组与疾病进展3组的生存曲线差异显著(Log-rankχ^(2)=4.117,P=0.042);疾病控制3组和疾病进展3组1年累积存活率分别为73.5%、48.5%。结论RECIST与mRECIST影像学评价结果与TACE联合仑伐替尼治疗的不可切除HCC患�Objective To investigate the relationship between the results of imaging evaluation and survival prognosis of patients with unresectable hepatocellular carcinoma(HCC)treated with transarterial chemoembolization(TACE)combined with lenvatinib and to find the earliest time node for imaging efficacy judgment.Methods The clinical data of 186 patients with unresectable HCC who were treated with TACE combined with Renvastinib at Xijing Digestive Disease Hospital and the Second Affiliated Hospital of Air Force Medical University from June 2019 to June 2022 were retrospectively analyzed.Survival prognostic factors were determined using Cox hazard proportional regression models,and patient outcomes were assessed according to the response evaluation criteria in solid tumors(RECIST)and modified RECIST(mRESICT).Kendall′s tau-b test was used for consistency analysis of imaging evaluation results.Kaplan-Meier method was used to draw the survival curve,and Log-rank test was used for inter-group survival analysis.Results The objective response rate(ORR)of RECIST evaluation was 17.8%(33/186),that of mRECIST evaluation was 43.0%(80/186),and Kendall′s tau-b correlation coefficient was 0.506(P<0.001).The disease control rate(DCR)of both RECIST and mRECIST standards was 71.0%(132/186),and Kendall′s tau-b correlation coefficient was 1.000(P<0.001).Multivariate Cox regression analysis showed that albumin,total bilirubin and RECIST/mRECIST standard DCR were independent influencing factors for survival and prognosis of patients(P<0.05).According to the review time and the disease control status of the RECIST/mRESICT standard evaluation indicators,the patients who were reviewed within 4 weeks were divided into disease control group 1(n=23)and disease progression group 1(n=5),and the patients who were reviewed after 4 to 6 weeks were divided into disease control group 2(n=47)and disease progression group 2(n=17).Patients who were re-examined 6 weeks and above were divided into disease control group 3(n=62)and disease progression group

关 键 词：肝细胞癌 经肝动脉化疗栓塞术 仑伐替尼 影像学评价 预后评估 

分 类 号：R735.7[医药卫生—肿瘤]