Heat Shock Protein 90alpha Predicts Clinical Prognosis Following Interventional Treatment Of Hepatocellular Carcinoma And Emergency Interventional Treatment For Head And Neck Tumor Hemorrhage

Background and ObjectiveAt the time of hepatocellular carcinoma(HCC)discovery,most of them are in the middle and late stage,and the chance of surgical resection or ablation is lost.Transarterial chemoembolization(TACE)is the most commonly used palliative treatment method.Specific biomarkers for predicting or monitoring the efficacy of TACE before or during TACE are of great significance for individualized treatment of advanced liver cancer patients.Heat shock protein 90α(Hsp 90α)is likely to be a specific biomarker for predicting or monitoring the efficacy of TACE.This study retrospectively analyzed the relationship between plasma Hsp90a levels and treatment response after 4 weeks and long-term prognosis after TACE of HCC.MethodsTo retrospectively collect clinical data of HCC patients who underwent TACE in the Department of Interventional Radiology,Cancer Hospital of Peking Union Medical College from August 2017 to December 2018,including baseline characteristics,treatment,and prognostic.To analyze the correlation between plasma hsp90a level and clinicopathological indexes before TACE.Univariate and multivariate analyses were performed by using logistic regression analysis to identify the factors associated with tumor response.The cumulative survival curves were created according to the Kaplan-Meier method and were compared with the results of the log-rank test.Univariate and multivariate Cox regression analysis was performed to assess the factors related to patient survival.ResultsA total of 96 patients in our department were enrolled from August 2017 to December 2018,including 84 male and 12 females,with an average age of 58.The high expression of plasma Hsp90α before TACE was significantly associated with tumor>5 cm(P=0.004),AFP>400 ng/mL(P=0.013),vascular invasion(P<0.001),and BCLC staging(P<0.001).The plasma Hsp90a levels of TACE responders decreased significantly(P<0.001)at 4 weeks after TACE compared with those before TACE,and no positive difference in plasma Hsp90a levels wereobserved of TACE nonresponders at 4 weeks after TACE compared with those before TACE(P=0.308).On univariate logistic regression analysis,Child-Pugh class(P=0.004),vascular invasion(P=0.006),baseline Hsp90α level(P=0.012),percentage decrease in plasma Hsp90a levels after TACE(P<0.001)were significant factors for tumor response afterTACE.On multivariate logistic regression analysis,Child-Pugh class(P=0.046),vascular invasion(P=0.025),percentage decrease in plasma Hsp90a levels after TACE(P<0.001)were independent significant factors for tumor responseafterTACE.Median PFS of patients with lower baseline plasma Hsp90a levels was significantly longer than those with higher Hsp90αlevels(9.7 months vs.8.4 months,P=0.036).Median PFS of patients with percentage decrease in plasma Hsp90a levels after TACE of>50%was significantly longer than those of 25%～50%and<25%(13.5 months v.s.9.6 months vs.7.4 months,P<0.001).On multivariate Cox regression analysis,BCLC staging(P<0.001),percentage decrease in plasma Hsp90α levels after TACE(P<0.001)were independent significant factors for patient survivalafterTACE.ConclusionsPercentage decrease in plasma Hsp90α levels 4 weeks after TACE is good predicting factor for tumorresponseand survival afterTACE.Besides,Child-Pugh class and vascular invasion are significant predictors of tumor response after TACE,and BCLC staging is good prognostic factors for survival.Background and objectiveHead and neck cancer was the seventh most common cancer worldwide in 2018(890,000 new cases and 450,000 deaths).Treatment methods mainly include surgical resection and/or combination of radiotherapy and chemotherapy.The most common complication is hemorrhage,up to 10%of advanced head and neck tumors are associated with major bleeding due to ulceration,an iatrogenic pseudoaneurysm,or chemoradiation treatment,delayed treatment often endangers the patient’s life.Head and neck cancer bleeding is usually managed with local pressure,suture closure,nasal packing,etc.Even if hemorrhage is controlled with conservative treatments,tumors can rebleed at unpredictable intervals.Surgical treatment is often considered an option after conservative treatment fails,management for bleeding from head and neck cancer has consisted of open surgical exploration with ligation of the involved vessels.However,surgical treatment is often difficult because of infections,fistulas,radiation-induced necrosis,or fibrosis and adhesion resulting from previous surgical exploration.In addition,this treatment is associated with relatively high mortality rates and high risk of neurological complications.Transarterial embolization(TAE),is a minimally invasive procedure and involves closing of the vessel that supplies the tumor by introducing an embolic agent into its lumen.A lot has changed in the technique since Duggan first used embolization as a method of selective control of bleedingin 1970,introduction of specifically shaped catheters,microcatheters and coaxial catheters allowed for superselective vascular catheters to be more precisely applied embolization agents into the vessels.In recent years,interventional embolization therapy has been applied more and more to the emergency management of head and neck.The purpose of this study was to retrospectively analyze the clinical data,summarize the clinical experience of interventional embolization and explore the clinical value of interventional embolization in the treatment of head and neck cancer related intractable bleeding.MethodsFrom February 2017 to February 2020,a total of 21 patients underwent emergency angiography and interventional embolization for the management of intractable tumor bleeding in head and neck cancer in author’s hospital.The tumor treatment history,bleeding history,angiography performance,technical success rate,clinical success rate and complications were retrospectively analyzed.Indications for angiography and embolization included persistent or repeated tumor bleeding that could not be controlled by conservative treatments.Abnormal imaging findings follows:contrast extravasation,pseudoaneurysm and tumor staining.ResultsThe positive rate of angiography was 100%(19/21).Selective angiogram revealing abnormal tumor staining in 10 cases,contrast media extravasation in 6 cases,pseudoaneurysm in 2 cases,negative angiography in 2 cases and external carotid artery rupture in 1 case.One patient with carotid rupture was transferred to a general hospital for treatment.The remaining 20 patients received a total of 22 times of interventional embolization.The technical success rate was 100%(22/22).Recurrence occurred in 4 patients within 30 days,and the clinical success rate was 80%(16/20).Mild maxillofacial pain occurred in 5 patients(25.0%)and no serious complications occurred.ConclusionsEmergency interventional embolization is safe and effective for the management of intractable tumor bleeding in head and neck cancer.Compared with surgical ligation,TAE can detect and determine the cause of bleeding and can selectively occlude the offending vessels.It is an effective,safe and repeatable treatment method for patients of head and neck cancer related intractable bleeding.