Abstract

Purpose

In patients with advanced hepatocellular carcinoma (HCC) treated with sorafenib, post-progression survival (PPS) is marked by the pattern of progression. Our aim was to assess the influence of the pattern of progression to selective internal radiotherapy (SIRT) in PPS among patients with HCC.

Methods

A retrospective analysis of patients treated with SIRT between 2003 and 2015 was conducted, excluding those with a single nodule < 5 cm or with metastases. Four patterns of progression to SIRT were defined: target tumour growth, non-target tumour growth, new intrahepatic disease, and new extrahepatic disease. PPS was calculated from the time of progression based on RECIST 1.1 criteria.

Results

Out of the 102 patients who met the selection criteria, 76 progressed after a median follow-up of 15 months. Median PPS was 6.5 months (95% CI 3.8–9.3 months). Patients who progressed at pre-existing lesions had a better PPS (median 12.5 months) than those who progressed with new lesions inside or outside the liver (median 4.2 months) (p = 0.02). In a Cox model adjusted by liver function and systemic inflammation, the pattern of progression had a hazard ratio of 1.64 (95% CI 0.92–2.93; p = 0.093).

Conclusion

In a cohort of HCC patients treated with SIRT, the pattern of progression associated with worst survival was the development of new intrahepatic lesions or extrahepatic metastases.

中文翻译：

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进展模式定义了接受SIRT治疗的肝细胞癌患者的进展后生存率。

摘要

目的

在索拉非尼治疗的晚期肝细胞癌（HCC）患者中，进展模式标志着进展后生存期（PPS）。我们的目的是评估肝癌患者中PPS的进展模式对选择性内部放射治疗（SIRT）的影响。

方法

对2003年至2015年接受SIRT治疗的患者进行回顾性分析，不包括单个结节<5 cm或有转移的患者。定义了四种进展为SIRT的模式：靶肿瘤生长，非靶肿瘤生长，新肝内疾病和新肝外疾病。根据RECIST 1.1标准从进展时间计算PPS。

结果

在满足选择标准的102位患者中，有76位在中位随访15个月后进展。PPS中位数为6.5个月（95％CI 3.8-9.3个月）。在已有病灶处进展的患者（在中位12.5个月）比在肝脏内外发生新病灶的患者（中位4.2个月）有更好的PPS（p  = 0.02）。在通过肝功能和全身性炎症调整的Cox模型中，进展模式的危险比为1.64（95％CI为0.92-2.93；p  = 0.093）。

结论

在接受SIRT治疗的HCC患者队列中，与最差生存率相关的进展模式是新的肝内病变或肝外转移的发展。