| PART ?To Evaluate and Compare the Prognostic Performance of MESIAH and mHAP-? Score in Predicting the Overall Survial in Patints with Hepatocellular Carcinoma Underwent RadioembolizationPurposeTo validate and compare the accuracy of MESIAH and mHAP-? score in predicting patients' survival after initial TARE.Methods and materialsAll patients with unresectable HCC and underwent TARE between August 2015 and June 2019 were retrospectively reviewed in this study.The diagnosis of HCC was based upon histology or criteria suggested by the American Association for the Study of Liver Diseases(AASLD).Data collecting included baseline demographic,laboratory parameters,tumor characteristics,treatment information,and follow up imformation.Database was construced by the information collected.Patients were excluded if had another malignancy in addition to HCC.MESIAH and mHAP-? scores were calculated based on the baseline data.Kaplan Meier method was used to estimate overall survival(OS)and draw survival curves for the whole cohort and subgroups created based the scores.Cox regression models were used to evaluate the association between MESIAH and mHAP-? scores and patients' overall survival after initial TARE treatment.Calibration of the MESIAH score at 6 and 12 months was done by creating calibration plots of observed vs predicted survival rates.The calibration analysis was also performed in subgroups stratified by clinical vriables.ResultsA total of 180 patients with HCC underwent TARE over a 4-year period,139(77%)were men and 44 were women(23%),with a mean age of 67.5±8.4 years.In all patients,the mean follow up was 13.08±8.22 months and 43 patients(24%)died during the study period.The mean MESIAH and mHAP-? score were 4.6±1.3 and 1.5±1 and patients were divided to four groups according to quartiles of MESIAH score and mHAP-? score stage,respectively.Kaplan Meier curve of the overall survival for groups with different MESIAH(Hazard ration,HR,2.315;95%Confidence Intervall,CI,1.847-2.900)and mHAP-?(HR,2.367;95%CI,1.847-2.900)scores showed that both of those two scores were able to stratify patients(P<0.001).The univariable Cox regression models showed that both MESIAH and mHAP-? scores were strongly associated with overall survival after TARE(P<0.0001).The observed 6-month and 12-month survival rate were 88.2%and 72.1%and mean predicted survival were 70±29%and 60±32%,respectively.The calibration plots showed that,the dots mostly fell into the top left side of the reference line,indicating that the MESIAH score tend to underestimate survival at 6 and 12 months.MESIAH score underestimate survival rates more severely in the subset of patients with vascular invasion and treated by immunotherapy.ConclusionBoth MESIAH and mHAP-? scores were proved to have a good performance in predicting OS in present study patients.MESIAH score has a better performance.The MESIAH score tend to underestimate the 6 and 12 months survival rate in all patients,the underestimation was more severe in subgroups of patients with vascular invasion and treated by immunotherapyPart ?To Evaluate the Efficacy of the Combination of Radioembolization and Check Point Inhibitors in Treating Hepatocellular CarcinomaPurposeTo evaluate the efficacy of the combination of TARE(Tansarterial Radioembolization)and immunotherapy in treating patients with HCCMethods and materialsThe database of HCC patients treated by TARE was used to screen all the BCLC-Cpatients.Patients'baseline demographics,liver function,laboratory parameters,tumor characteristics,and types and time of systemic therapy(Immunotherapy,Multikinase inhibitor,Chemotherapy)received after TARE.Patients were divided into different groups according to if had immunotherapy and vascular invasion/extrahepatic metastasis.The OS,time to progress(TTP),and 3 month tumor response were evaluated between groups.Tomore response was evaluated based on mRECIST criteraResultsA total of 79 patients were included in this study,59(74.7%)were men and 20 were women(25.3%),with a mean age of 67.5±9.5 years.Among them,38 had systemic therapy included 25 immunotherapy,33 multikinase inhibitor,and 1 chemotherapy.There were 21 patients received both immunotherapy and multikinase inhibitor.Between patients who had immunotherapy and did not receive systemic therapy after TARE,no significant difference were found for OS and TTP(P>0.05).In 40 patients with vascular invasion/extrahepatic metastasis,23 had immunotherapy and 17 did not receive systemic therapy.Between them,OS was significant different(P=0.021),TTP,and ORR(Objective response rate)and DCR(Disease control rate)of were not different(P>0.05)ConclusionIn BCLC-C stage patients with vascular invasion/extrahepatic metastasis,those who treated by the combination of TARE and immunotherapy have a longer OS compared with who had TARE only.It indicates that this combination was effectivePart ?To Evaluate the Correlation of Nuetrophil to Lymphocyte Ratio and Overall Survival in Patients with Hepatocellular Carcinoma Underwent RadioembolizationPurposeTo compare the prognostic significance of pretreatment NLR(Pre NLR),posttreatment NLR(Post NLR)and change in NLR(?NLR)in patients with HCC treated by TAREMethods and materialsPatients were reviewed by using the database of HCC patients treated by TARE.Patients with missing pre-or post-treatment complete blood count(in 1 week before and 1 month after)were excluded.Medical records and images were reviewed for demographics,laboratory results,tumor characteristics and radioembolization parameters.NLR variables associated with overall survival(OS)were determined by BCLC stage dependent univariate and multivariate analyses.The clinical parameters correlated with the OS predictor were also exploredResultsA total of 162 patients were included in this study,124(76.5%)men and 38(23.5%)women,with a mean age of 67.5±8.3 years.The mean follow-up of all patients was 11.5±7.9 months;38 patients died during the study period.One-and 2-year survival rates were 76.0%and 54.9%,respectively.The estimated median OS was 27.9 months.Post neutrophil(HR,1.237;95%CI,1.017-1.505;P=0.033),post NLR(HR,1.063;95%CI,1.010-1.119;P=0.019)and ?NLR(HR,1.610;95%CI,1.105-2.348;P=0.013)were associated with OS in BCLC C stage patients,and ?NLR was confirmed to be an independent predictor(HR,0.393;95%CI,0.156-0.994;P=0.049).Volume of liver tissue treated,delivered dose,and treatment activity were significantly correlated with ?NLR(P<0.05)with a correlation coefficient of 0.365,-0.187,and-0.177,respectively.ConclusionElevated ?NLR is associated with a worse OS in BCLC C stage patients after TARE Volume of liver tissue treated is the parameter that most correlated with ?NLR. |
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