[1]徐李刚,张 巍,钱 晟,等.经导管动脉化疗栓塞成功转化的初始不可切除肝癌术前预测模型的临床研究[J].介入放射学杂志,2022,31(07):670-674.
XU Ligang,ZHANG Wei,QIAN Sheng,et al.The establishment of preoperative predictive model used for predicting TACE-transformed initially-inoperable HCC: a clinical study[J].journal interventional radiology,2022,31(07):670-674.
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经导管动脉化疗栓塞成功转化的初始不可切除肝癌术前预测模型的临床研究()
《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]
- 卷:
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31
- 期数:
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2022年07
- 页码:
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670-674
- 栏目:
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肿瘤介入
- 出版日期:
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2022-09-03
文章信息/Info
- Title:
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The establishment of preoperative predictive model used for predicting TACE-transformed initially-inoperable HCC: a clinical study
- 作者:
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徐李刚; 张 巍; 钱 晟; 瞿旭东; 颜志平; 王建华; 刘萍萍; 王 栋; 杨国威; 刘 嵘
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- Author(s):
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XU Ligang; ZHANG Wei; QIAN Sheng; JU Xudong; YAN Zhiping; WANG Jianhua; LIU Pingping; WANG Dong; YANG Guowei; LIU Rong.
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Department of Interventional Radiology, Jing’an Branch, Affiliated Huashan Hospital, Fudan University, Shanghai 200040, China
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- 关键词:
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【关键词】 不可切除肝癌; 补救性肝切除; 经导管动脉化疗栓塞; 预测模型
- 文献标志码:
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A
- 摘要:
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【摘要】 目的 了解经导管动脉化疗栓塞(TACE)联合补救性肝切除(SLR)治疗初始不可切除肝细胞癌(HCC)的疗效及其影响因素,构建SLR术前选择性预后预测模型。方法 回顾性分析2010年1月至2016年12月在复旦大学附属中山医院接受TACE+SLR治疗的119例初始不可切除HCC患者的临床资料。随访36个月,存活时间≥36个月患者82 例(长期存活组),存活时间<36个月患者37 例(短期存活组)。通过卡方检验和Cox多因素回归模型确定SLR前的关键因素,构建接受TACE+SLR治疗HCC患者的SLR术前选择性预后预测Nomogram模型。结果 119例患者的1、2、3年总生存率(OS)分别为90.8%、80.6%、68.6%。SLR术前AFP>20 ng/mL、癌灶数目≥4个、TACE治疗后肿瘤负荷降低<0.15、门脉癌栓(PVTT)和主瘤最大径>10 cm等是影响预后、增加死亡风险的SLR术前关键因素。基于上述5个关键因素构建新的SLR前预后预测Nomogram模型,其C指数=0.781(95% CI:0.714~0.848),具有较好的预测患者生存的准确性和区分能力。结论 TACE联合SLR治疗初始不可切除肝癌患者疗效确切。基于SLR前AFP水平、癌灶数目、肿瘤负荷下降水平、PVTT、主瘤最大径构建的Nomogram模型能较好地预测初始不可切除HCC患者接受TACE+SLR治疗的预后。
参考文献/References:
[1] Global Burden of Disease Liver Cancer Collaboration, Akinyemiju T, Abera S,et al. The burden of primary liver cancer and underlying etiologies from 1990 to 2015 at the global, regional, and national level: results from the global burden of disease study 2015[J]. JAMA Oncol, 2017, 3: 1683- 1691.
[2] Department of Medical Administration, National Health and Health Commission of the People’s Republic of China. Guidelines for diagnosis and treatment of primary liver cancer in China(2019 edition)[J]. Zhonghua Gan Zang Bing Za Zhi, 2020, 28:112- 128.
[3] Lencioni R, De Baere T, Soulen MC, et al. Lipiodol transarterial chemoembolization for hepatocellular carcinoma: a systematic review of efficacy and safety data[J]. Hepatology, 2016, 64: 106- 116.
[4] 张 雯,周永杰,颜志平. 再论精细TACE[J]. 介入放射学杂志, 2021, 30:971- 975.
[5] 赵海涛,桑新亭,芮静安,等. 不能手术切除的晚期肝癌降期后切除疗效分析[J]. 中国医学科学院学报, 2009, 31:503- 505.
[6] 中国抗癌协会肝癌专业委员会转化治疗协作组. 肝癌转化治疗中国专家共识(2021版)[J]. 中华消化外科杂志, 2021, 20:600- 616.
[7] Zhang ZF, Luo YJ, Lu Q, et al. Conversion therapy and suitable timing for subsequent salvage surgery for initially unresectable hepatocellular carcinoma: what is new?[J]. World J Clin Cases, 2018, 6: 259- 273.
[8] International Bladder Cancer Nomogram Consortium, Bochner BH, Kattan MW, et al. Postoperative nomogram predicting risk of recurrence after radical cystectomy for bladder cancer[J]. J Clin Oncol, 2006, 24: 3967- 3972.
[9] Karakiewicz PI, Briganti A, Chun FK, et al. Multi- institutional validation of a new renal cancer- specific survival nomogram[J]. J Clin Oncol, 2007, 25: 1316- 1322.
[10] Xu L, Peng ZW, Chen MS, et al. Prognostic nomogram for patients with unresectable hepatocellular carcinoma after transcatheter arterial chemoembolization[J]. J Hepatol, 2015, 63: 122- 130.
[11] de Baere T, Arai Y, Lencioni R, et al. Treatment of liver tumors with lipiodol TACE: technical recommendations from experts opinion[J]. Cardiovasc Intervent Radiol, 2016, 39: 334- 343.
[12] Shi M, Guo RP, Lin XJ, et al. Partial hepatectomy with wide versus narrow resection margin for solitary hepatocellular carcinoma: a prospective randomized trial[J]. Ann Surg, 2007, 245: 36- 43.
[13] Rahbari NN, Koch M, Schmidt T, et al. Meta- analysis of the clamp- crushing technique for transection of the parenchyma in elective hepatic resection: back to where we started?[J]. Ann Surg Oncol, 2009, 16: 630- 639.
[14] Villanueva A. Hepatocellular carcinoma[J]. N Engl J Med, 2019, 380: 1450- 1462.
[15] Yang SL, Liu LP, Yang S, et al. Preoperative serum α- fetoprotein and prognosis after hepatectomy for hepatocellular carcinoma[J]. Br J Surg, 2016, 103: 716- 724.
[16] Wang YK, Bi XY, Li ZY, et al. A new prognostic score system of hepatocellular carcinoma following hepatectomy[J]. Zhonghua Zhong Liu Za Zhi, 2017,39: 903- 909.
[17] Wakayama K, Kamiyama T, Yokoo H, et al. Huge hepatocellular carcinoma greater than 10 cm in diameter worsens prognosis by causing distant recurrence after curative resection[J]. J Surg Oncol, 2017, 115: 324- 329.
[18] 江 旭,李 慧,刘 航,等. 影响肝细胞癌切除术后早期复发及生存的危险因素分析[J]. 介入放射学杂志, 2018, 27:215- 222.
[19] 夏永祥,张 峰,李相成,等. 原发性肝癌10 966例外科治疗分析[J]. 中华外科杂志, 2021, 59:6- 17.
[20] 陈邦飞,樊 嘉,吴志全,等. 肝细胞肝癌化疗栓塞后二期切除22例临床分析[J]. 中国临床医学, 1999, 6:121- 122.
[21] Luo J, Peng ZW, Guo RP, et al. Hepatic resection versus trans-arterial lipiodol chemoembolization as the initial treatment for large, multiple, and resectable hepatocellular carcinomas:a prospective nonrandomized analysis[J]. Radiology, 2011, 259: 286- 295.
[22] Zhang Y, Huang G, Wang Y, et al. Is salvage liver resection necessary for initially unresectable hepatocellular carcinoma patients downstaged by transarterial chemoembolization? Ten years of experience[J]. Oncologist, 2016, 21: 1442- 1449.
备注/Memo
- 备注/Memo:
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(收稿日期:2021- 11- 22)
(本文编辑:新 宇)
更新日期/Last Update:
2022-09-02