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PLoS One. 2014;9(11):e113926.

Comparison of the effects of transarterial chemoembolization for advanced hepatocellular carcinoma between patients with and without extrahepatic metastases.

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제1저자 유정주 · 교신저자 이정훈

PMID 25427152 PMC4245068 DOI 10.1371/journal.pone.0113926 IF 2.8 소화기내과
소속 (2)
  1. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
  2. Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.

Abstract

BACKGROUND/AIMS Sorafenib is a standard treatment for advanced hepatocellular carcinoma (HCC) (Barcelona Clinic Liver Cancer [BCLC] stage C). However, transarterial chemoembolization (TACE) has also been widely used as a treatment for patients with advanced HCC, even if they have extrahepatic metastases (EHM). The aim of this study was to determine the efficacy of TACE for advanced HCC patients with EHM upon initial diagnosis, as compared with those patients without EHM.

METHODS This cohort study involved consecutive patients who underwent TACE as an initial treatment for advanced HCC. One hundred seventy-seven patients with EHM (the EHM group) and 205 with portal vein invasion without EHM (the non-EHM group) were included. A survival analysis was performed to compare overall survival between the two groups.

RESULTS The mean age was 54.5±9.9 years, and median follow-up duration was 13.1 months (range, 0.5-111.0). Overall survival was significantly shorter in the EHM group than the non-EHM group (median, 8.3 vs. 19.1 months; P<0.001). A multivariate analysis showed that the presence of EHM was an independent poor prognostic factor for shorter overall survival (adjusted hazard ratio, 1.74; 95% confidence interval, 1.39-2.17; P<0.001) after adjustment for Child-Pugh classification, intrahepatic tumor T classification, tumor response to TACE, and serum alpha-fetoprotein level. Patients administered TACE and systemic therapy demonstrated a better survival rate than those administered TACE alone in both the EHM (median, 13.5 vs. 7.2 months) and non-EHM groups (median, 27.9 vs. 18.2 months) (both, P<0.05).

CONCLUSIONS The prognosis of advanced HCC patients with EHM is significantly worse than those without EHM administered repeated TACE treatments, even if their tumor stage was similar to BCLC stage C. These results suggest that EHM presence means aggressive tumor biology and that BCLC stage C might be subclassified according to EHM presence.

Figures

Figure 1
Figure 1 Kaplan-Meier survival curve for the EHM and the non-EHM group. Within the same BCLC stage C, the OS of the EHM group (solid line) was worse than the non-EHM group (dotted line) (median, 8.3 months vs. 19.1 months; P<0.001).
Figure 2
Figure 2 Survival analysis based on tumor response. Responders (CR+PR according to mRECIST, dotted line) showed a better OS, as compared with non-responders (SD+PD, solid line), regardless of the presence of EHM, both (A) in the EHM group (median, 9.4 months vs. 6.5 months; P = 0.005) and (B) in the non-EHM group (median, 21.9 months vs. 10.8 months, P = 0.003).
Figure 3
Figure 3 Survival analysis based on intrahepatic stage and liver function. Subgroup analysis based on the intrahepatic stage and liver function was undertaken. The solid line represents patients with EHM and the dotted line for patients without EHM: The graphs demonstrates the comparisons of OS between the EHM group and the non-EHM group (A) in patients with T3 intrahepatic tumor (median, 8.7 months vs. 20.0 months; P<0.001), (B) in those with T4 tumor (median, 5.1 months vs. 7.5 months; P = 0.287), (C) in those with Child-Pugh class A liver function (median, 9.5 months vs. 21.9 months; P<0.001), and (D) in those with Child-Pugh class B (5.1 months vs. 10.7 months; P = 0.021), respectively.
Figure 4
Figure 4 Survival analysis based on treatment modalities. The combination group (TACE with systemic chemotherapy, dotted line) showed a better OS than the TACE group (TACE without systemic chemotherapy, solid line), irrespective of EHM, both (A) in the EHM group (median, 13.5 months vs. 7.2 months; P = 0.008) and (B) in the non-EHM group (median, 27.9 months vs. 18.2 months; P = 0.043).

그림 출처: PubMed Central 공개 논문 (PMC4245068)

Conflict of interest statement

Competing Interests:The authors have declared that no competing interests exist.

그 밖의 정보
출판 형태
Comparative Study, Journal Article
저널
PloS one · eISSN 1932-6203
전자 출판
2014-11-26
MeSH
Adult · Carcinoma, Hepatocellular / pathology / therapy · Chemoembolization, Therapeutic / methods · Female · Humans · Liver / pathology · Liver Neoplasms / pathology / therapy · Male · Middle Aged · Neoplasm Metastasis / pathology / therapy · Survival Analysis · Treatment Outcome
참고문헌
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