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Identifying optimal candidates for post-TIPS patients with HCC undergoing TACE: a multicenter observational study

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机构: [1]Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, People’s Republic of China [2]Department of Ultrasonic, The First Affiliated Hospital of Sun Yatsen University, Guangzhou, People’s Republic of China [3]Department of Gastroenterology, Nanfang Hospital, Guangzhou, People’s Republic of China [4]Department of Interventional Radiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, People’s Republic of China [5]Department of Interventional Radiology, The First People’s Hospital of Yulin, Yulin, Guangxi, People’s Republic of China [6]Department of Intervention, The First Affiliated Hospital of Guangzhou Pharmaceutical University, Guangzhou, People’s Republic of China [7]Department of Intervention, Guangdong Second Provincial General Hospital, Guangzhou, People’s Republic of China [8]Liver and Gall Surgical Department, Gaozhou People’s Hospital, Gaozhou, People’s Republic of China [9]Interventional Vascular Department, Huizhou First Hospital, Huizhou, People’s Republic of China [10]Department of Liver and Gallbladder Surgery, Hainan General Hospital, Haikou, People’s Republic of China [11]Interventional Department, Dongguan People’s Hospital, Dongguan, People’s Republic of China [12]Department of Radiology, Jiangmen Central Hospital, Jiangmen, People’s Republic of China [13]Department of Interventional Oncology, Jinshazhou Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China
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To develop a prognostic model for post-transjugular intrahepatic portosystemic shunt (TIPS) patients with hepatocellular carcinoma (HCC) beyond the Milan criteria treated by transarterial chemoembolization (TACE).Between January 2013 and January 2020, 512 patients with HCC beyond the Milan criteria who underwent TACE after TIPS were retrospectively recruited from 15 tertiary centers. Patients were randomly sorted into a training set (n = 382) and a validation set (n = 130). Medical data and overall survival were assessed. A prediction model was developed using multivariate Cox regression analyses. Predictive performance and discrimination were evaluated and compared with other prognostic models.Vascular invasion, log10(AFP), 1/creatinine, extrahepatic spread, and log10(ALT) were the most significant prognostic factors of survival. These five parameters were included in a new VACEA score. This score was able to stratify patients in the training set into four distinct risk grades whose median overall survival were 25.2, 15.1, 8.9, and 6.2 months, respectively. The 6-month, 1-year, 2-year, and 3-year AUROC values and C-index of the VACEA model were 0.819, 0.806, 0.779, 0.825, and 0.735, respectively, and higher than those of other seven currently available models in both the training and validation sets, as well as in different subgroups.The VACEA score could stratify post-TIPS patients with HCC beyond the Milan criteria treated by TACE and help to identify candidates who benefit from this treatment.• Vascular invasion, AFP, creatinine, extrahepatic spread, and ALT were independent significant prognostic factors of survival for HCC patients who underwent TACE after TIPS. • Our new model, named VACEA score, can accurately predict prognosis at the individual level and stratify patients into four distinct risk grades. • The VACEA model showed better prognostic discrimination and calibration than other current TACE-/TIPS-specific models Graphical abstract.© 2022. The Author(s).

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出版当年[2022]版:
大类 | 2 区 医学
小类 | 2 区 核医学
最新[2025]版:
大类 | 2 区 医学
小类 | 2 区 核医学
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出版当年[2021]版:
Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
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Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

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第一作者机构: [1]Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, People’s Republic of China
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