TBS和放疗后AFP稳定时间对肝细胞癌合并PVTT患者预后的影响

The impact of TBS and post-radiotherapy AFP stabilization time on prognosis in HCC patients complicated with PVTT

目的探讨肿瘤负荷评分(TBS)和放疗后甲胎蛋白(AFP)稳定时间对肝细胞癌(HCC)合并门静脉癌栓(PVTT)患者预后的影响。方法回顾性分析新疆医科大学附属肿瘤医院2018年7月至2022年3月符合入组标准的40例HCC合并PVTT患者的资料。观察全组患者客观缓解率(ORR)、总生存(OS)、无进展生存(PFS)、AFP反应及放疗后AFP稳定时间,受试者操作特征(ROC)曲线制订诊断界值,通过Kaplan-Meier法分析生存,并用log-rank检验比较生存率差异,采用Cox比例风险模型进行多因素分析。结果TBS的最佳截止值为4.27[曲线下面积(AUC)=0.752,P=0.018]。全组患者ORR为35.7%,中位OS期和PFS期分别为8、5个月,中位AFP稳定时间为6个月。单因素分析结果显示有9个因素与OS相关,分别为性别、肿瘤最长径、TBS、中国肝癌分期、谷草转氨酶(AST)/谷丙转氨酶(ALT)比值、谷氨酰转肽酶(GGT)、放疗剂量、AFP稳定时间、肿瘤反应。多因素分析结果显示TBS>4.27(HR=0.195,95%CI为0.060~0.638,P=0.007)、中国肝癌分期为Ⅲb期(HR=0.328,95%CI为0.144~0.745,P=0.008)、AFP稳定时间≤6个月(HR=10.282,95%CI为2.304~45.883,P=0.002)是影响HCC合并PVTT患者OS的独立危险因素。结论低TBS、放疗后AFP稳定时间长的HCC合并PVTT患者OS可能会更长,TBS和AFP的联合有望成为新的风险评估模式。

ObjectiveTo investigate the effects of tumor burden score(TBS)and post-radiotherapy alpha-fetoprotein(AFP)stabilization time on the prognosis of hepatocellular carcinoma(HCC)patients complicated with portal vein tumor thrombus(PVTT).MethodsClinical data of 40 eligible HCC patients complicated with PVTT admitted to the Affiliated Tumor Hospital of Xinjiang Medical University from July 2018 to March 2022 were retrospectively analyzed.The objective response rate(ORR),overall survival(OS),progression-free survival(PFS),AFP response,and post-radiotherapy AFP stabilization time in the entire group were observed.Diagnostic thresholds were determined by the receiver operating characteristic(ROC)curve.Survival analysis was conducted by Kaplan-Meier method,and the differences of survival rate were assessed by log-rank test.Multivariate analysis was performed by Cox proportional risk model.ResultsThe optimal cut-off value for TBS was 4.27[area under the ROC curve(AUC)=0.752,P=0.018].The ORR in the entire group was 35.7%,with a median OS and PFS of 8 and 5 months,respectively.The median AFP stabilization time was 6 months.Univariate analysis showed that a total of 9 factors were associated with OS,including gender,maximum tumor diameter,TBS,China liver cancer staging,aspartate aminotransferase(AST)/alanine aminotransferase(ALT)ratio,gamma-glutamyl transferase(GGT),radiation dose,AFP stabilization time,and tumor response.Multivariate analysis showed that TBS>4.27(HR=0.195,95%CI=0.060-0.638,P=0.007),China liver cancer stageⅢb staging(HR=0.328,95%CI=0.144-0.745,P=0.008),and AFP stabilization time≤6 months(HR=10.282,95%CI=2.304-45.883,P=0.002)were the independent risk factors for OS in HCC patients complicated with PVTT.ConclusionHCC patients complicated with PVTT who have low TBS and AFP stabilization time after radiotherapy may obtain longer OS,and the combination of TBS and AFP is expected to become a new risk assessment model.