Abstract：
BACKGROUND: Hepatic arterial infusionchemotherapy (HAIC) is a promising option for large unresectable hepatocellular carcinoma (HCC). Identifying patients who could benefit from continuous HAIC remains a challenge. We aimed to establish an objective model to guide the decision for retreatment with HAIC.
METHODS: Between 2015 and 2020, the data of patients with large unresectable HCC without macrovascular invasion or extrahepatic spread undergoing multiple HAIC cycles from 3 different centers were retrieved. We investigated the basic tumor parameters and the effect of HAIC on liver function and tumor response, and their impact on overall survival (OS). A point score (ARH, Assessment for Retreatment with HAIC) was built by using a stepwise Cox regression model in the training cohort (n = 112) and was validated in an independent validation cohort (n = 71).
RESULTS: The high α-fetoprotein before the second cycle of HAIC, an increase in Child-Pugh score, and undesirable radiologic tumor responses remained independent negative prognostic factors and were used to create the ARH score. The prognosis of HCC patients deteriorated significantly with the increase in ARH score. The median OS of patients with ARH score 0-2 points and ≥ 2.5 points were 19.37 months and 11.60 months (P < 0.001). All of these results had been confirmed in the external validation cohort and demonstrated significance across multiple subgroups.
CONCLUSIONS: The ARH score makes an excellent prediction of the prognosis of HCC patients who received retreatment of HAIC. Patients with an ARH score ≥ 2.5 prior to the second cycle of HAIC may not profit from further sessions.
METHODS: Between 2015 and 2020, the data of patients with large unresectable HCC without macrovascular invasion or extrahepatic spread undergoing multiple HAIC cycles from 3 different centers were retrieved. We investigated the basic tumor parameters and the effect of HAIC on liver function and tumor response, and their impact on overall survival (OS). A point score (ARH, Assessment for Retreatment with HAIC) was built by using a stepwise Cox regression model in the training cohort (n = 112) and was validated in an independent validation cohort (n = 71).
RESULTS: The high α-fetoprotein before the second cycle of HAIC, an increase in Child-Pugh score, and undesirable radiologic tumor responses remained independent negative prognostic factors and were used to create the ARH score. The prognosis of HCC patients deteriorated significantly with the increase in ARH score. The median OS of patients with ARH score 0-2 points and ≥ 2.5 points were 19.37 months and 11.60 months (P < 0.001). All of these results had been confirmed in the external validation cohort and demonstrated significance across multiple subgroups.
CONCLUSIONS: The ARH score makes an excellent prediction of the prognosis of HCC patients who received retreatment of HAIC. Patients with an ARH score ≥ 2.5 prior to the second cycle of HAIC may not profit from further sessions.
摘要：
背景：肝动脉灌注化疗（HAIC）是大型不可切除肝细胞癌（HCC）的有希望的选择。确定可以从持续HAIC中受益的患者仍然是一个挑战。我们旨在建立一个客观模型来指导HAIC再治疗的决策。
方法：在2015年至2020年之间，检索了来自3个不同中心的无大血管侵犯或肝外扩散的大型不可切除HCC患者的数据。我们研究了基本的肿瘤参数和HAIC对肝功能和肿瘤反应的影响，以及它们对总生存期(OS)的影响。一分得分(ARH，在训练队列（n=112）中使用逐步Cox回归模型建立了HAIC复治评估），并在独立验证队列（n=71）中进行了验证。
结果：在HAIC的第二个周期前，高甲胎蛋白，Child-Pugh分数的增加,和不良的放射学肿瘤反应仍然是独立的负预后因素,并用于创建ARH评分.随着ARH评分的增加，HCC患者的预后明显恶化。ARH评分0～2分及≥2.5分患者的中位OS分别为19.37个月和11.60个月(P<0.001)。所有这些结果已在外部验证队列中得到证实，并证明了多个亚组的显著性。
结论：ARH评分能很好地预测接受HAIC再治疗的HCC患者的预后。在HAIC的第二个周期之前ARH评分≥2.5的患者可能无法从进一步的治疗中受益。
方法：在2015年至2020年之间，检索了来自3个不同中心的无大血管侵犯或肝外扩散的大型不可切除HCC患者的数据。我们研究了基本的肿瘤参数和HAIC对肝功能和肿瘤反应的影响，以及它们对总生存期(OS)的影响。一分得分(ARH，在训练队列（n=112）中使用逐步Cox回归模型建立了HAIC复治评估），并在独立验证队列（n=71）中进行了验证。
结果：在HAIC的第二个周期前，高甲胎蛋白，Child-Pugh分数的增加,和不良的放射学肿瘤反应仍然是独立的负预后因素,并用于创建ARH评分.随着ARH评分的增加，HCC患者的预后明显恶化。ARH评分0～2分及≥2.5分患者的中位OS分别为19.37个月和11.60个月(P<0.001)。所有这些结果已在外部验证队列中得到证实，并证明了多个亚组的显著性。
结论：ARH评分能很好地预测接受HAIC再治疗的HCC患者的预后。在HAIC的第二个周期之前ARH评分≥2.5的患者可能无法从进一步的治疗中受益。
