Introduction: The purpose of this study was to evaluate the treatment efficacy of transcatheter arterial chemo-embolization (TACE) for treatment-naive hepatocellular carcinoma (HCC) according to tumor location and burden. Methods: Between 2010 and 2019, consecutive patients who underwent TACE as the first treatment were enrolled. Tumors were classified into two categories based on their location, as central or peripheral tumors. Tumors in the central zone, which is within 1 cm of the main trunk or the first branch of the portal vein, were classified as central tumors, while those located in the peripheral zone were classified as peripheral tumors. Patients were grouped according to the HCC location and up-to-7 criteria. Patients with central tumors were classified into the central arm and those with only peripheral tumors were classified into the peripheral arm. Patients within and beyond the up-to-7 criteria were classified into the up-to-7 in and up-to-7 out groups, respectively. Local recurrence-free survival (LRFS) and progression-free survival (PFS) were compared per-nodule (central tumor vs. peripheral tumor) and per-patient (central arm vs. peripheral arm), respectively. The prognostic factors of LRFS and PFS were analyzed by univariate and multivariate analyses. Results: A total of 174 treatment-naive patients with 352 HCCs were retrospectively enrolled. Ninety-six patients and 130 lesions were selected by propensity score matching. Median LRFS was longer for peripheral tumors than central tumors (not reached vs. 3.3 months, p<0.001). Median PFS was: 17.1 months (8.3-24.9) in the peripheral arm up-to-7 in, 7.0 months (3.3-12.7) in the peripheral arm up-to-7 out, 8.4 months (4.0-12.6) in the central arm up-to-7 in, and 3.0 months (1.2-4.9) in the central arm up-to-7 out groups. The peripheral arm up-to-7 in group had significantly longer PFS than the other three groups (p=0.013, p=0.015, p<0.001, respectively). Multivariate analysis confirmed that the central zone and central arm were associated with high adjusted hazard ratios for tumor recurrence or death (2.87, p<0.001; 2.89, p<0.001, respectively). Conclusion: Treatment-naive HCCs in the peripheral zone had a longer LRFS and PFS following TACE compared to those in the central zone.


中文翻译：

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TACE 治疗初治 HCC 具有不同的治疗效果，具体取决于中心或外周肿瘤位置

简介：本研究的目的是根据肿瘤位置和负荷评估经导管动脉化疗栓塞术 (TACE) 治疗初治肝细胞癌 (HCC) 的疗效。方法：在 2010 年至 2019 年间，连续纳入了接受 TACE 作为首次治疗的患者。肿瘤根据其位置分为两类，即中央肿瘤或周围肿瘤。位于主干或门静脉第一支1cm以内的中心区肿瘤为中心性肿瘤，位于周边区的为周围型肿瘤。根据 HCC 位置和最多 7 个标准对患者进行分组。患有中心性肿瘤的患者被归类为中央组，而仅患有周围性肿瘤的患者被归类为周围性组。up-to-7 标准以内和之外的患者分别分为 up-to-7 in 和 up-to-7 out 组。局部无复发生存期 (LRFS) 和无进展生存期 (PFS) 分别按结节（中心肿瘤与外周肿瘤）和每位患者（中心臂与外周臂）进行比较。通过单变量和多变量分析分析LRFS和PFS的预后因素。结果：共回顾性纳入了 174 名初治患者和 352 个 HCC。通过倾向评分匹配选择了 96 名患者和 130 个病灶。外周肿瘤的中位 LRFS 比中心肿瘤长（未达到 vs. 3.3 个月，p<0.001）。中位 PFS 为：外周臂 17.1 个月 (8.3-24.9) 最多 7 进，外周臂 7.0 个月 (3.3-12.7) 最多 7 出，中央臂 8.4 个月 (4.0-12.6) 最多-7 个月和 3.0 个月 (1.2-4.9) 在中央臂最多 7 个外组。组中最多 7 个外周臂的 PFS 明显长于其他三组（分别为 p=0.013、p=0.015、p<0.001）。多变量分析证实，中央区和中央臂与肿瘤复发或死亡的高校正风险比相关（分别为 2.87，p<0.001；2.89，p<0.001）。结论：与中心区相比，周边区初治 HCC 在 TACE 后的 LRFS 和 PFS 更长。6) 中央臂最多 7 进，中央臂 3.0 个月 (1.2-4.9) 最多 7 出组。组中最多 7 个外周臂的 PFS 明显长于其他三组（分别为 p=0.013、p=0.015、p<0.001）。多变量分析证实，中央区和中央臂与肿瘤复发或死亡的高校正风险比相关（分别为 2.87，p<0.001；2.89，p<0.001）。结论：与中心区相比，周边区初治 HCC 在 TACE 后的 LRFS 和 PFS 更长。6) 中央臂最多 7 进，中央臂 3.0 个月 (1.2-4.9) 最多 7 出组。组中最多 7 个外周臂的 PFS 明显长于其他三组（分别为 p=0.013、p=0.015、p<0.001）。多变量分析证实，中央区和中央臂与肿瘤复发或死亡的高校正风险比相关（分别为 2.87，p<0.001；2.89，p<0.001）。结论：与中心区相比，周边区初治 HCC 在 TACE 后的 LRFS 和 PFS 更长。多变量分析证实，中央区和中央臂与肿瘤复发或死亡的高校正风险比相关（分别为 2.87，p<0.001；2.89，p<0.001）。结论：与中心区相比，周边区初治 HCC 在 TACE 后的 LRFS 和 PFS 更长。多变量分析证实，中央区和中央臂与肿瘤复发或死亡的高校正风险比相关（分别为 2.87，p<0.001；2.89，p<0.001）。结论：与中心区相比，周边区初治 HCC 在 TACE 后的 LRFS 和 PFS 更长。