A Series Of Clinical Researches On Early Prediction Of TACE Refractoriness Hepatocarcinoma And The Preliminary Analysis Of The Treatment For TACE Refractoriness

Objectives1.To explore whether the ART,ABCR score and JSH-LCSGJ-2014 criterion can be used to identify TACE refractoriness in local Chinese population.2?To investigate the value of clinical nomogram for early identification of TACE refractoriness based on the TRIPOD statement.3?To explore the value of arterial phase-based radiomics-clinical nomogram for early prediction of TACE refractoriness.4?To explore the appropriate treatment for TACE refractoriness hepatocellular carcinoma.Materials and methodsIn Chapter 1,the clinical data of patients who treated with TACE in the Affiliated Hospital of Chengdu University were retrospectively analyzed.The patients were divided into different groups according to ART score,ABCR score and JSH-LCSGJ-2014 standard.The difference of median OS was analyzed by Kaplan-Meier method.Cox regression analysis was used to determine risk factors that predicted OS.In Chapter 2,the data of patients who received TACE treatment in two third-class teaching hospitals were retrospectively analyzed.Univariate and multivariate Cox regression analysis was used to identify clinical risk factors of TACE refractoriness,and the predictive clinical nomogram was established.The difference of median OS was analyzed by Kaplan-Meier method.The calibration curve and decision curve analysis(DCA)was conducted to determine the clinical usefulness and calibration degree of the clinical nomogram.All analyses were conducted according to TRIPOD statement.In Chapter 3,the subjects were selected by the same methods as in the chapter 2,ICC and LASSO regression analyses were used.Cox regression analysis was used to establish the clinical-radiomics nomogram.The difference of median OS was analyzed by Kaplan-Meier method.The calibration curve and decision curve analysis(DCA)was conducted to determine the clinical usefulness and calibration degree of the newly constructed nomogram.All analyses were conducted according to TRIPOD statement.In Chapter 4,the data of patients who received TACE treatment in the Affiliated Hospital of Chengdu University were retrospectively analyzed.The patients were divided into three treatment groups:TACE treatment group,Apatinib treatment group,HAIC combined with apatinib treatment group.Kaplan-Meier method was used to analyze the differences of median OS,TTP and child-Pugh score between different groups.Univariate and multivariate Cox regression analysis was conducted to analyze the independent predictors of OS.ResultsIn Chapter 1,the ART score and ABCR score can not distinguish TACE resistance,however,the JSH-LCSGJ-2014 standard can distinguish TACE resistance.In Chapter 2,multivariate Cox regression analysis showed that BCLC stage,irregular tumor margin,maximum tumor diameter and multiple tumor were independent predictors of OS.They were divided into low and high-risk groups with markedly different prognoses in the training and validation cohorts.The calibration curve and decision curve analyses verified the usefulness of the nomogram for clinical practice.In Chapter 3,8 features were selected to build the radiomics signature using the LASSO regression model.Multivariate Cox regression analysis showed that BCLC stage,irregular tumor margin,maximum tumor diameter,multiple tumors and Radiomics-score were independent predictors of OS.They were divided into low and high-risk groups with markedly different prognoses in training and validation cohorts.The calibration curve and decision curve analyses proved the usefulness of the nomogram for clinical practice.The accuracy of the clinical-radiomics nomogram was considerably higher than that of the other four models.In Chapter 4,Kaplan-Meier method demonstrated that there was significant difference in liver function change between group C and group A(P<0.05),however,there was no significant difference between group C and group B(P>0.05);there was significant difference in TTP and median OS between group C and other groups(P<0.05).Multivariate analysis showed that change to HAIC combined with Apatinib treatment was the only independent predictor of OS.In terms of side-effects,the rates of grade 3-4 side-effects between group C and other groups have significant difference(P<0.05).ConclusionsJSH-LCSGJ-2014 standard can be used to identify TACE refractoriness.The nomogram based on routine imaging findings and clinical related factors can be used to early identify the TACE refractoriness,but if combined with radiomics technology,its ability to early identify TACE refractoriness is significantly improved.For TACE refractoriness,HAIC combined with apatinib can achieve longer OS and TTP than other treatments,and the adverse-effects can be acceptable.