| Objective:To analyze the correlation between preoperative blood perfusion parameters of adjacent liver tissue and tumor and progression-free survival(PFS)and overall survival(OS)after embolization for hepatocellular carcinoma(HCC).Methods:1.Patients diagnosed with HCC and treated with Transcatheter Arterial Chemoembolization(TACE)in our hospital from July 2014 to December 2018 were retrospectively analyzed.The diagnosis of HCC was based on histological results or imaging diagnostic criteria proposed by the Guidelines for the Diagnosis and Treatment of Primary Liver Cancer(2022 edition)led by the National Health Commission of the People’s Republic of China.2.The Arterial Enhancement Fraction of Cancer adjacent Liver tissue(L-AEF),The Hepatic Artery Blood Supply Coefficient of Cancer adjacent Liver tissue(L-HAC),The Portal Vein Blood Supply Coefficient of Cancer adjacent Liver tissue(L-PVC),The Arterial Enhancement Fraction of Tumor(T-AEF),The Hepatic Artery Blood Supply Coefficient of Tumor(T-HAC),The Portal Vein Blood Supply Coefficient of Tumor(T-PVC)in each patient was calculated from the Region of Interest(ROI)delineated by preoperative perfusion enhanced CT in HCC patients.At the same time,pre-operative laboratory indicators and tumor characteristics of the patients were collected and analyzed,and the collected information was used to build a database.3.Univariate COX scaling regression models were used to analyze the correlation between blood supply and perfusion parameters,tumor and peritoneal liver tissue,preoperative laboratory indicators and preoperative tumor characteristics,and PFS and OS after TACE in all HCC patients.Related metrics were included in the multivariate COX scaled regression model analysis to identify independent predictors of PFS and OS.Log-rank tests were used to analyze the correlation between independent predictors and progression-free and overall survival,and Kaplan-Meier methods were used to plot progression-free and overall survival curves.Tumors were divided into two groups based on the optimal cut-off for the perfusion parameter and the differences between the two groups were analyzed to explore possible implications and mechanisms affecting the perfusion parameter.Results:1.A total of 113 HCC patients were enrolled in this study,including 97 males(85.8%)and 16 females(14.2%).The age of onset was over 60 years in 40 patients(35.4%)and under 60 years in 73 patients(64.6%).The main cause of liver disease was hepatitis B virus and cirrhosis caused by it(68.1%).The CNLC stage was mainly stage Ⅱb to Ⅲb,accounting for 81.4%.2.COX regression analysis showed that T-AEF(HR: 2.012,95% CI: 1.277-3.170)was an independent predictor of PFS(all P < 0.05).3.T-PVC(HR: 0.418,95%CI: 0.210-0.833),T-AEF(HR: 1.925,95%CI:1.171-3.167),aspartate aminotransferase(AST)(HR: 3.293,95%CI: 1.747-6.208)and alpha-fetoprotein(AFP)(HR: HR: 1.669,95%CI: 1.003-2.778)were independent predictors of OS(all P < 0.05).4.The median PFS for all patients was 0.78 years,with progression-free survival rates of 59.3%,42.5%,27.4% and 19.2% at six months,one,two and three years,respectively.The median OS for all patients was 2.04 years.The half-year,one-year,three-year and five-year survival rates were 92.9%,82.3%,36.3% and 21.8%respectively.5.The median PFS of patients with T-AEF ≥ 0.718 was 0.48(0.21-1.26)years,and that of patients with T-AEF < 0.718 was 1.40(0.24-3.86)years(P < 0.001).6.The median OS of patients with T-PVC ≥ 0.210 was 2.07(1.34-4.19)years,and that of patients with T-PVC < 0.210 was 1.44(0.94-2.18)years.The median OS of patients with T-AEF ≥ 0.718 was 1.79(0.90-3.22)years,and the median OS of patients with T-AEF < 0.718 was 2.66(1.55-4.82)years.The median OS was 1.81(1.08-3.23)years in AST > 40U/L group and 3.90(2.36-5.64)years in AST ≤40U/L group.The median OS was 1.84(1.05-3.30)years in AFP > 10ng/ml group and 3.68(1.82-5.73)years in AFP ≤ 10ng/ml group(all P < 0.05).7.Using the best cut-off point(T-PVC=0.210,T-AEF=0.718),T-PVC and T-AEF were divided into high and low groups respectively.There was a significant difference in Lactate Dehydrogenase between the two groups of T-PVC(P=0.004).There was no significant difference in T-AEF between the two groups(all P > 0.05).Conclusions:1.Tumor AEF predicts progression-free survival in patients with HCC after TACE treatment;PVC,AEF,AST,and AFP predict overall survival in patients with HCC after TACE treatment.2.HCC with T-AEF ≥ 0.718 was prone to tumor progression after embolization,and the progression-free survival was shorter;patients with T-PVC < 0.210,T-AEF≥ 0.718,AST > 40U/L,and AFP > 10ng/ml had shorter overall survival after TACE.3.Possible reasons for T-PVC being an independent predictor of OS are related to LDH and tumor progression;Possible reasons why T-AEF is an independent predictor of PFS and OS were not found in the present study. |
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