索拉菲尼治疗肝细胞癌的有效性与其影像学动脉血供有关

Arterial blood supply of hepatocellular carcinoma is associated with efficacy of sorafenib therapy

目的：探索索拉菲尼治疗肝细胞癌的有效性与其CT或MRI影像学特征之间的关系,分析索拉菲尼治疗肝细胞癌病人的预后因素,探索影像学表现与预后之间的关系。方法：自2009年4月-2010年12月,收集38例连续的接受索拉菲尼治疗的肝细胞癌患者。根据肿瘤在CT或MRI上动脉期的表现,可分为动脉期富血供与贫血供两组。收集两组病人的临床资料,用Kaplan-Meier法计算生存时间。结果：38例接受索拉菲尼治疗的肝细胞癌病人中,中位年龄（53.3±11.1）岁,其中男性35人,占92.1%。17例动脉期富血供,21例富血供。中位生存时间10.7个月（95%CI：8.7-12.7）,1年总体生存率41.0%。肿瘤富血供的中位生存时间及1年总体生存率分别为12个月（4-20个月）及52.9%,而贫血供的分别为7个月（1-16个月）及23.8%（P=0.002）。接受索拉菲尼治疗的BCLC B级的肝癌患者中位生存时间及1年总体生存率均明显优于BCLC C级的患者,但两组间差异无统计学意义。多因素分析结果显示：肿瘤的动脉血供是影响接受索拉菲尼治疗的肝癌患者疗效的预测因素（HR,0.22;95%CI：0.07-0.67;P=0.008）。结论：肝癌动脉血供是索拉菲尼治疗肝癌患者疗效的预测因素,富血供的肝癌患者接受索拉菲尼治疗比贫血供的肝癌患者获益更多。

Objective： There are some previous reports concerning the relationship between prognosis of patients treated with sorafenib and parameters of computed tomography（CT） and magnetic resonance imaging（MRI）. We present our monocentric experience with sorafenib in the treatment of hepatocellular carcinoma（HCC） patients trying to identify predictive factors for survival placing emphasis on the correlation of imaging findings and survival. Methods： From April 2009 to December 2010, a total of 38 HCC patients treated with sorafenib were included in this study. HCCs were classified as good arterial supply and poor arterial supply according to the enhancement intensity on CT scan or MRI. Clinical data were collected and survival time was analyzed by KaplanMeier method. A Cox＇s regression model was performed to reveal predictive factors for survival. Results： Among the 38 patients treated with sorafenib, median age was 53.3±11.1 years and 35（92.1%） were males. Tumors in 17 patients were classified as good arterial supply while the remained 21 patients belonged to poor arterial supply. The median survival time（MST） was 10.7 months（95% CI： 8.7-12.7） and the 1-year overall survival（OS） was 41.0%.The MST and 1-year OS in patients with good arterial supply of tumors were 12（range, 4-20） months and 52.9%,compared with that of 7（range, 1-16） months and 23.8% in patients with poor arterial supply of tumors（P=0.002）.Patients who had tumors at BCLC stage B had longer MST and higher OS than those who had tumors at BCLC stage C, but there was no difference between these two stages statistically. On multivariate analysis, arterial supply of the tumors remained statistically predictive for overall survival（HR, 0.22; 95% CI： 0.07-0.67; P=0.008）.Conclusion： Arterial blood supply is an independent predictor for survival in patients treated with sorafenib, and patients with good arterial supply of tumors benefit more than those with poor arterial supply of tumors.