Factors impacting survival after transarterial radioembolization in patients with hepatocellular carcinoma: Results from the prospective CIRT study

被引:27
作者
Kolligs, Frank [1 ]
Arnold, Dirk [2 ]
Golfieri, Rita [3 ]
Pech, Maciej [4 ]
Peynircioglu, Bora [5 ]
Pfammatter, Thomas [6 ]
Ronot, Maxime [7 ,8 ]
Sangro, Bruno [9 ,10 ,11 ]
Schaefer, Niklaus [12 ]
Maleux, Geert [13 ]
Munneke, Graham [14 ]
Pereira, Helena [15 ,18 ]
Zeka, Bleranda [16 ]
de Jong, Niels [16 ]
Helmberger, Thomas [17 ]
Gol, R.
Pech, Maciej [4 ]
Peynircioglu, Bora [5 ]
Pfammatter, Thomas [6 ]
Ronot, Maxime [7 ,8 ]
Sangro, Bruno [9 ,10 ,11 ]
Schaefer, Niklaus [12 ]
Maleux, Geert [13 ]
Munneke, Graham [14 ]
Pereira, Helena [15 ,18 ]
Zeka, Bleranda [16 ]
Helmberger, Thomas [17 ]
机构
[1] Helios Klinikum Berlin Buch, Dept Internal Med & Gastroenterol, Berlin, Germany
[2] Asklepios Tumorzentrum Hamburg, AK Altona, Oncol & Hematol, Hamburg, Germany
[3] IRCCS Azienda Osped Univ Bologna, Dept Radiol, Bologna, Italy
[4] Univ Magdeburg, Dept Radiol & Nucl Med, Magdeburg, Germany
[5] Hacettepe Univ, Sch Med, Dept Radiol, Sihhiye Campus, Ankara, Turkiye
[6] Univ Spital Zurich, Inst Diagnost & Intervent Radiol, Zurich, Switzerland
[7] Univ Paris Cite, Paris, France
[8] Hop Beaujon, APHP Nord, Serv Radiol, Clichy, France
[9] Clin Univ Navarra, Liver Unit, Pamplona, Spain
[10] Clin Univ Navarra, HPB Oncol Area, Pamplona, Spain
[11] CIBEREHD, Pamplona, Spain
[12] CHU Vaudois, Serv Med Nucl & Imagerie Mol, Lausanne, Switzerland
[13] Univ Ziekenhuis Leuven, Radiol, Leuven, Belgium
[14] Univ Coll London Hosp NHS Fdn Trust, Intervent Oncol, London, England
[15] Hop Europeen Georges Pompidou, AP HP, Unite Rech Clin, Paris, France
[16] Cardiovasc & Intervent Radiol Soc Europe, Dept Clin Res, Neutorgasse 9, A-1010 Vienna, Austria
[17] Klinikum Bogenhausen, Dept Radiol Neuroradiol & Minimal Invas Therapy, Munich, Germany
[18] INSERM, Ctr Invest Clin 1418, Paris, France
关键词
SIRT; observational; liver; radioembolization; dosimetry; registry; INTERNAL RADIATION-THERAPY; QUALITY-OF-LIFE; Y-90; RADIOEMBOLIZATION; MICROSPHERE RADIOEMBOLIZATION; RESIN MICROSPHERES; LIVER-FUNCTION; SORAFENIB; SAFETY; DOSIMETRY; EFFICACY;
D O I
10.1016/j.jhepr.2022.100633
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background & Aims: Transarterial radioembolization (TARE) with Yttrium-90 resin microspheres is an established treatment option for patients with hepatocellular carcinoma (HCC). However, optimising treatment application and patient selection remains challenging. We report here on the effectiveness, safety and prognostic factors, including dosing methods, associated with TARE for HCC in the prospective observational CIRT study. Methods: We analysed 422 patients with HCC enrolled between Jan 2015 and Dec 2017, with follow-up visits every 3 months for up to 24 months after first TARE. Patient characteristics and treatment-related data were collected at baseline; adverse events and time-to-event data (overall survival [OS], progression-free survival [PFS] and hepatic PFS) were collected at every 3-month follow-up visit. We used the multivariable Cox proportional hazard model and propensity score matching to identify independent prognostic factors for effectiveness outcomes. Results: The median OS was 16.5 months, the median PFS was 6.1 months, and the median hepatic PFS was 6.7 months. Partition model dosimetry resulted in improved OS compared to body surface area calculations on multivariable analysis (hazard ratio 0.65; 95% CI 0.46-0.92; p = 0.0144), which was confirmed in the exact matching propensity score analysis (hazard ratio 0.56; 95% CI 0.35-0.89; p = 0.0136). Other independent prognostic factors for OS were ECOG-performance status >0 (p = 0.0018), presence of ascites (p = 0.0152), right-sided tumours (p = 0.0002), the presence of portal vein thrombosis (p = 0.0378) and main portal vein thrombosis (p = 0.0028), ALBI grade 2 (p = 0.0043) and 3 (p = 0.0014). Adverse events were recorded in 36.7% of patients, with 9.7% of patients experiencing grade 3 or higher adverse events. Conclusions: This large prospective observational dataset shows that TARE is an effective and safe treatment in patients with HCC. Using partition model dosimetry was associated with a significant improvement in survival outcomes. Impact and implications: Transarterial radioembolization (TARE) is a form of localised radiation therapy and is a potential treatment option for primary liver cancer. We observed how TARE was used in real-life clinical practice in various European countries and if any factors predict how well the treatment performs. We found that when a more complex but personalised method to calculate the applied radiation activity was used, the patient responded better than when a more generic method was used. Furthermore, we identified that general patient health, ascites and liver function can predict outcomes after TARE. Clinical trial number: NCT02305459. (c) 2022 The Author(s). Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL). This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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页数:12
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