Up-to-seven criteria as a useful predictor for tumor downstaging to within Milan criteria and Child-Pugh grade deterioration after initial conventional transarterial chemoembolization

作者：Yasui Yutaka; Tsuchiya Kaoru; Kurosaki Masayuki; Takeguchi Takaya; Takeguchi Yuko; Okada Mao; Wang Wan; Kubota Yohei; Goto Tomoyuki; Komiyama Yasuyuki; Higuchi Mayu; Takaura Kenta; Hayashi Tsuguru; Takada Hitomi; Tamaki Nobuharu; Nakanishi Hiroyuki; Itakura Jun; Takahashi Yuka; Asahina Yasuhiro; Enomoto Nobuyuki; Himeno Yoshiro; Izumi Namiki^*

来源：Hepatology Research, 2018, 48(6): 442-450.

DOI：10.1111/hepr.13048

• hepatocellular carcinoma
• intermediate-stage
• liver function
• transarterial chemoembolization
• up-to-seven criteria

Aim: Intermediate-stage hepatocellular carcinoma varies widely in tumor burden and liver function. This study aimed to clarify the importance of subclassification by the up-to-seven criteria in both clinical course and liver function deterioration in such patients.
Methods: We retrospectively analyzed 224 patients with Child-Pugh grade A who underwent initial transarterial chemoembolization (TACE) for hepatocellular carcinoma. Tumor downstaging to within the Milan criteria within 1year and liver function worsening as Child-Pugh grade deterioration from A to B were analyzed.
Results: The median survival time was 35.8 months. Forty-five patients had no recurrence within 1year after initial TACE. Of the 179 patients with at least one recurrence within a year, 44 (25%) achieved tumor downstaging to within the Milan criteria and showed significantly longer survival than non-downstaged ones (P = 0.02). Logistic regression univariate analysis revealed that up-to-seven criteria fulfillment was associated with tumor downstaging to within the Milan criteria (odds ratio 2.6; P = 0.007). The median deterioration time was 26.7 months. Multivariate analysis revealed that beyond the up-to-seven criteria (hazard ratio [HR] 1.9; P = 0.005) was an independent factor associated with Child-Pugh grade deterioration, along with serum albumin (HR 1.54; P = 0.01), serum bilirubin (HR 1.49; P = 0.02), and prothrombin time (HR 1.54; P = 0.04).
Conclusions: The up-to-seven criteria had prognostic value and could predict non-critical recurrence and maintenance of Child-Pugh grade in patients who underwent initial conventional TACE.

• 出版日期2018-5