한빛사 논문
Abstract
Beom Kyung Kim1, 2, Seung Up Kim1, 2,*, Kyung Ah Kim5, Yong Eun Chung3, Myeong-Jin Kim3, Mi-Suk Park3, Jun Yong Park1, 2, Do Young Kim1, 2, Sang Hoon Ahn1, 2, 4, Man Deuk Kim3, Sung Il Park3, Jong Yoon Won3, Do Yun Lee3, Kwang-Hyub Han1, 2, 4
1Department of Internal Medicine, 2Yonsei Institute of Gastroenterology, 3Department of Radiology, Yonsei University College of Medicine, 4Brain Korea 21 Project for Medical Science, Seoul, Republic of Korea and 5Department of Radiology, St. Vincent’s Hospital, The Catholic University of Korea, Gyeonggi-do, Republic of Korea
*Corresponding author: Seung Up Kim, M.D., Ph.D.
Department of Internal Medicine, Yonsei University College of Medicine 50-1 Yonsei-ro, Seodaemun.gu, Seoul, 120.752, Republic of Korea
Abstract
Backgrounds/Aims
The aim of this study is to evaluate prognostic significances of not only the initial and the best response during repeated trans-arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC), if eligible, but also time-point of achieving treatment responses.
Methods
Treatment-naive 314 patients with well-preserved liver function undergoing TACE were recruited. Treatment responses were assessed using modified Response Evaluation Criteria in Solid Tumors. Overall survival (OS) was analyzed using Kaplan-Meier methods and Cox-regression analysis was performed for multivariate analysis.
Results
After adjusting other variables, objective response (complete response [CR] and partial response [PR]) as the initial response (adjusted hazard ratio [HR] 0.410) and the best response (adjusted HR 0.335) had independent prognostic significances for OS, respectively (both p<0.001). Objective responders as the initial response had the longest OS, followed by patients who subsequently achieved objective response after at least two sessions and those who did not achieve objective response during treatment course eventually (52.6, 27.0, and 10.8 months, respectively; log-rank test, p<0.001). Likewise, patients with CR as the initial response had the longest OS, followed by those who subsequently achieved CR after at least two sessions and those who achieved PR as the best response (70.2, 40.6, and 23.0 months, respectively; log-rank test, p<0.001). Large (>5cm) and multiple (>3) tumors were independently associated with failure to achieve CR after the initial TACE (both p<0.05).
Conclusion
Both the initial and the best response predicts OS effectively. However, achievement of treatment response at early time-point is still the robust predictor for favorable outcomes.
Keywords : Hepatocellular carcinoma; Chemoembolization; Initial response; Best response; Prognosis
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