경동맥화학색전술 불응성인 Child-Pugh Class A 간세포암 환자의 간기능 악화에 대한 위험인자

Background/Aims: A switch to systemic therapy, such as sorafenib, should be considered for hepatocellular carcinoma (HCC) pa­tients refractory to transarterial chemoembolization (TACE). On the other hand, treatment changes are difficult if the liver function worsens to Child-Pugh B or C. Therefore,...

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Veröffentlicht in:The Korean journal of gastroenterology 2020-03, Vol.75 (3), p.147
Hauptverfasser: 박강현, Kang Hyun Park, 김정한, Jeong Han Kim, 최원혁, Won Hyeok Choe, 권소영, So Young Kwon, 유병철, Byung Chul Yoo, 황진호, Jin Ho Hwang, 박상우, Sang Woo Park, 김영준, Young Jun Kim, 박희선, Hee Sun Park, 유미혜, Mi Hye Yu, 전혜정, Hae Jeong Jeon
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Zusammenfassung:Background/Aims: A switch to systemic therapy, such as sorafenib, should be considered for hepatocellular carcinoma (HCC) pa­tients refractory to transarterial chemoembolization (TACE). On the other hand, treatment changes are difficult if the liver function worsens to Child-Pugh B or C. Therefore, predicting the risk factors for non-responsiveness to TACE and deteriorating liver function may be helpful. Methods: Newly diagnosed Child-Pugh A HCC patients who underwent TACE from January 2012 to June 2018 were included. After 1 year, this study evaluated whether there was a treatment response to TACE and whether the Child-Pugh class had worsened. Results: Among 121 patients, 65 were refractory and 56 responded to TACE. In multivariable logistic regression analysis, the tu­mor size, tumor number, and albumin at the time of the diagnosis of HCC were significant prognostic factors for the treatment re­sponse to TACE. Among 65 patients who presented TACE-refractoriness, 27 showed liver function deterioration from Child-Pugh class A to class B or C after TACE. In multivariable logistic regression analysis, bilirubin at the diagnosis of HCC was a significant prognostic factor for liver function deterioration. A predictive algorithm based on the regression equations revealed a sensitivity, specificity, positive predictive value, and negative predictive value of 74.1%, 74.5%, 45.5%, and 90.9%, respectively, for TACE-re­fractoriness and liver function deterioration. Conclusions: The prognostic model incorporating the tumor size, tumor number, albumin, and bilirubin at the diagnosis of HCC may help identify patients who show a poor response to TACE and aggravation of liver function after TACE, who may benefit from early switching into systemic therapy before liver function aggravation.
ISSN:1598-9992