Supplementary Material for: Radiologic response as a prognostic factor in advanced hepatocellular carcinoma with macroscopic vascular invasion after transarterial chemoembolization and radiotherapy

Introduction: We evaluated the radiologic response rate of combined transarterial chemoembolization (TACE) plus radiotherapy (RT) in treatment-naïve patients with liver-confined hepatocellular carcinoma (HCC) with macroscopic vascular invasion (MVI) and analyzed its clinical importance in overall survival (OS) outcomes. Methods: Patients who were treated with TACE plus RT as a first-line treatment for HCC with MVI between January 2010 and December 2015 were retrospectively reviewed. Radiologic response was assessed according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) at 2- and 4-months after completion of RT. Landmark analysis at 2- and 4-months and time-dependent Cox regression analysis using response as a time-dependent covariate were performed for univariable and multivariable analyses. Results: The 2-month landmark analysis included 427 patients, and the 4-month landmark analysis included 355 patients after excluding patients without imaging studies for response evaluation at 4 months. Radiologic responses were observed in 210 (49.2%) patients at 2 months and 181 (51.8%) at 4 months. In multivariable analyses, radiologic response was identified as an independent prognosticator for OS at 2 months (median OS: responders, 23.1 months vs. non-responders, 8.0 months; hazard ratio [HR], 3.194; P < 0.001) and 4 months (median OS: responders, 26.5 months vs. non-responders, 9.3 months; HR, 4.534; P < 0.001). Conclusion: Radiologic response assessed by mRECIST was a significant prognostic factor for OS in patients with advanced-stage HCC showing MVI treated with combined TACE plus RT.

引言：本研究评估了经动脉化疗栓塞术（transarterial chemoembolization, TACE）联合放射治疗（radiotherapy, RT）针对初治、伴肉眼可见血管侵犯（macroscopic vascular invasion, MVI）且病灶局限于肝脏的肝细胞癌（hepatocellular carcinoma, HCC）患者的影像学缓解率，并分析其对总生存期（overall survival, OS）结局的临床意义。
方法：本研究回顾性分析了2010年1月至2015年12月期间，以TACE联合RT作为一线治疗方案的伴MVI的HCC患者资料。在放射治疗结束后2个月及4个月时，依据实体瘤疗效评价标准改良版（modified Response Evaluation Criteria in Solid Tumors, mRECIST）评估影像学缓解情况。分别以2个月和4个月为界点进行界标分析，并以缓解状态作为时变协变量，采用时间依赖性Cox回归模型开展单因素及多因素分析。
结果：2个月界标分析共纳入427例患者；在排除4个月时无影像学评估资料的患者后，4个月界标分析共纳入355例患者。治疗结束后2个月时，共有210例（49.2%）患者达到影像学缓解，4个月时则为181例（51.8%）。多因素分析显示，在2个月界标分析中，影像学缓解是OS的独立预后因素（缓解组中位OS：23.1个月，未缓解组：8.0个月；风险比[HR]=3.194，P<0.001）；在4个月界标分析中同样如此（缓解组中位OS：26.5个月，未缓解组：9.3个月；HR=4.534，P<0.001）。
结论：对于接受TACE联合RT治疗的伴MVI的晚期肝细胞癌患者，依据mRECIST评估的影像学缓解情况是其OS的显著预后因素。