恒瑞医疗 网址: www.hrmedical.com.cn

专业文献

阿霉素洗脱微球经导管肝动脉栓塞化疗的疗效评估:一个5年移植队列的肿瘤生物学和肝细胞癌复发情况研究-ag捕鱼平台

文字: 2018-7-6    浏览次数:820    


materials and methods: in this institutional review board–approved hipaa-compliant retrospective analysis, 93 consecutive patients (73 male, 20 female; mean age, 59.6 years; age range, 23–72 years) underwent tace with doxorubicin-eluting microspheres (deb) (hereafter, deb-tace) and subsequently underwent transplantation over a 5-year period from july 7, 2011, to may 16,2016. deb-tace response was based on modified response evaluation criteria in solid tumors. imaging responses and post transplantation recurrence were compared with demographics, liver function, basic immune markers, treatment dose, and tumor morphology. treatment response and recurrence were analyzed with uni-and multivariate statistics, as well as internal validation and propensity score matching of factors known to affect recurrence to assess independent effects of deb-tace response on recurrence.


材料和方法:在这个机构审查委员会批准的符合hipaa标准的回顾性分析中, 连续入组93名患者(男性73人,女性20人;平均年龄59.6岁;年龄跨度:23-72岁),接受多柔比星洗脱微球肝动脉栓塞化疗(deb-tace),随后5年的时间里接受肝移植(2011年7月7日~2016年5月16日)。通过mrecist评估deb-tace 治疗反应。在不同的人口,肝功能,基础免疫指标,治疗剂量和肿瘤形态患者中,对比肿瘤影像学反应和移植后复发情况。对治疗反应和复发进行单因素和多因素分析,并通过内部验证和已知影响复发因素的倾向评分匹配来评估deb-tace治疗反应对复发的独立影响。


results: low-grade tumors (grade 0, 1, or 2) demonstrated a favorable longterm treatment response in 87% of patients (complete response, 49%; partial response, 38%; stable disease [sd] or local disease progression [dp], 13%)versus 33% of high-grade tumors (grade 3 or 4) (complete response, 0%; partial response, 33%; sd or dp, 67%) (p , .001). of the 93 patients who underwent treatment, 82 were followed-up after transplantation (mean duration, 757 days).recurrence occurred in seven (9%) patients (mean time after transplantation,635 days). poor response to deb-tace (sd or dp) was present in 86% of cases and accounted for 35% of all patients with sd or dp (p , .001). by using only variables routinely available prior to liver transplantation, a validated model of post transplantation recurrence risk was produced with a concordance statistic of 0.83. the validated model shows sensitivity of 83.6%, specifcity of 82.6%, and negative predictive value of 98.4%, which are pessimistic estimates.


结果:低度恶性肿瘤(0-2级)长期治疗缓解率更高,达到87%(cr:49%;pr:38%;疾病稳定[sd]或局部疾病进展[dp]:13%),高度恶性肿瘤(3-4级)的缓解率为 33%(cr:0%;pr:33%;sd或dp:67%) (p < .001)。93名接受治疗的患者中,82人接受移植后随访(平均随访时间,757天)。其中7人(9%)复发(平均移植后时间635天)。这些患者中86%为deb-tace治疗低反应(sd或 dp),占sd或dp患者的35%(p <0 .001)。仅使用肝移植前常规的变量,建立了一个经确认的移植后复发风险的预测模型,其一致性统计为0.83。保守估计该模型敏感性为83.6%,特异性为82.6%,阴性预测值为98.4%。


conclusion: response to deb-tace is correlated with tumor biology and patients at risk for post transplantation recurrence, and it may be associated with hcc recurrence after liver transplantation.


结论:肿瘤生物学和移植后高复发风险患者可影响deb-tace治疗反应,而deb-tace治疗反应可能与肝移植术后hcc复发有关。