Key prognostic factors in transarterial chemoembolization combined with sorafenib treatment for hepatocellular carcinoma with portal vein tumor thrombosis.
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Abstract
Background: Hepatocellular carcinoma (HCC) is a prevalent malignancy worldwide, with portal vein tumor thrombosis (PVTT) worsening its prognosis and complicating management. The combination of transarterial chemoembolization (TACE) and the targeted agent sorafenib has been proposed to improve treatment outcomes. This study investigates the prognostic factors influencing the effectiveness of this combined treatment in HCC patients with PVTT.
Methods: A retrospective cohort study was conducted on 299 patients diagnosed with HCC and PVTT who underwent TACE and sorafenib treatment between January 2018 and December 2022. Patients were categorized into good-prognosis (n = 197) and poor-prognosis (n = 102) groups based on Response Evaluation Criteria in Solid Tumors (RECIST) assessed four weeks post-treatment. Prognostic factors were analyzed using univariate and multivariate analyses to identify significant determinants affecting therapeutic outcomes.
Results: Key prognostic factors included tumor number, differentiation, size, PVTT extent, Child-Pugh class, ECOG performance status, hospitalization duration, and AFP levels. Patients with a single tumor had better outcomes (OR 0.358, P = 0.002), whereas poor differentiation (OR 4.561, P = 0.005) and larger tumor size (OR 0.347, P < 0.001) were associated with worse prognosis. A higher Child-Pugh class (OR 0.563, P = 0.035) and better ECOG performance (OR 2.710, P = 0.025) improved prognosis, while prolonged hospitalization and elevated AFP levels were linked to poorer outcomes. ASA classification and HCC morphology did not significantly impact prognosis.
Conclusion: The prognosis of HCC with PVTT treated with TACE and sorafenib is significantly influenced by tumor characteristics, liver function, and overall patient health. Identifying these factors can aid in refining personalized treatment strategies to improve survival outcomes.
背景：肝细胞癌（HCC）是一种世界范围内普遍存在的恶性肿瘤，门静脉肿瘤血栓形成（PVTT）使其预后恶化并使治疗复杂化。经动脉化疗栓塞（TACE）和靶向药物索拉非尼（sorafenib）的联合治疗已被提出以改善治疗结果。本研究探讨影响肝细胞癌合并PVTT联合治疗效果的预后因素。方法：对2018年1月至2022年12月期间接受TACE和索拉非尼治疗的299例HCC和PVTT患者进行回顾性队列研究。根据治疗后4周评估的实体瘤应答评价标准（RECIST），将患者分为预后良好组（197例）和预后不良组（102例）。使用单变量和多变量分析分析预后因素，以确定影响治疗结果的重要决定因素。结果：关键预后因素包括肿瘤数量、分化程度、大小、PVTT程度、Child-Pugh分级、ECOG表现状态、住院时间、AFP水平。单一肿瘤患者预后较好（OR 0.358, P = 0.002），而分化差（OR 4.561, P = 0.005）和肿瘤较大（OR 0.347, P < 0.001）与预后较差相关。较高的Child-Pugh分级（OR 0.563, P = 0.035）和较好的ECOG表现（OR 2.710, P = 0.025）改善预后，而延长住院时间和AFP水平升高与较差的预后相关。ASA分级和HCC形态对预后无显著影响。结论：TACE联合索拉非尼治疗PVTT肝细胞癌的预后受肿瘤特征、肝功能及患者整体健康状况的显著影响。识别这些因素可以帮助改进个性化的治疗策略，以提高生存结果。
期刊介绍：
The American Journal of Cancer Research (AJCR) (ISSN 2156-6976), is an independent open access, online only journal to facilitate rapid dissemination of novel discoveries in basic science and treatment of cancer. It was founded by a group of scientists for cancer research and clinical academic oncologists from around the world, who are devoted to the promotion and advancement of our understanding of the cancer and its treatment. The scope of AJCR is intended to encompass that of multi-disciplinary researchers from any scientific discipline where the primary focus of the research is to increase and integrate knowledge about etiology and molecular mechanisms of carcinogenesis with the ultimate aim of advancing the cure and prevention of this increasingly devastating disease. To achieve these aims AJCR will publish review articles, original articles and new techniques in cancer research and therapy. It will also publish hypothesis, case reports and letter to the editor. Unlike most other open access online journals, AJCR will keep most of the traditional features of paper print that we are all familiar with, such as continuous volume, issue numbers, as well as continuous page numbers to retain our comfortable familiarity towards an academic journal.
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