한빛사 논문
Jinhong Junga, Ji Hyeon Jooa,*, So Yeon Kimb, Jin Hyoung Kimb, Jonggi Choic, Danbi Leec, Ju Hyun Shimc, Kang Mo Kimc, Young-Suk Limc, Han Chu Leec, Jin-hong Parka, Sang Min Yoona
aDepartment of Radiation Oncology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
bDepartment of Radiology and the Research Institute of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
cDepartment of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
*Current address:Department of Radiation Oncology, Pusan National University Yangsan Hospital, Yangsan, Gyeongsangnam-do, Republic of Korea
Jinhong Jung and Ji Hyeon Joo contributed equally to this work as co-first authors.
Corresponding author: Sang Min Yoon, M.D., Ph.D.
Abstract
Introduction: We evaluated the radiologic response rate of combined transarterial chemoembolization (TACE) plus radiotherapy (RT) in treatment-naïve patients with liver-confined hepatocellular carcinoma (HCC) with macroscopic vascular invasion (MVI) and analyzed its clinical importance in overall survival (OS) outcomes. Methods: Patients who were treated with TACE plus RT as a first-line treatment for HCC with MVI between January 2010 and December 2015 were retrospectively reviewed. Radiologic response was assessed according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) at 2- and 4-months after completion of RT. Landmark analysis at 2- and 4-months and time-dependent Cox regression analysis using response as a time-dependent covariate were performed for univariable and multivariable analyses. Results: The 2-month landmark analysis included 427 patients, and the 4-month landmark analysis included 355 patients after excluding patients without imaging studies for response evaluation at 4 months. Radiologic responses were observed in 210 (49.2%) patients at 2 months and 181 (51.8%) at 4 months. In multivariable analyses, radiologic response was identified as an independent prognosticator for OS at 2 months (median OS: responders, 23.1 months vs. non-responders, 8.0 months; hazard ratio [HR], 3.194; P < 0.001) and 4 months (median OS: responders, 26.5 months vs. non-responders, 9.3 months; HR, 4.534; P < 0.001). Conclusion: Radiologic response assessed by mRECIST was a significant prognostic factor for OS in patients with advanced-stage HCC showing MVI treated with combined TACE plus RT.
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