Purpose: This study examines the association between tumor volume doubling time (TVDT) and clinical outcomes for patients with hepatocellular carcinoma (HCC) treated with transarterial embolization (TAE) and evaluates the impact of tumor genotype on TVDT. Methods: This was a retrospective cohort study at a single tertiary care cancer center, including treatment-naïve patients with biopsy-proven HCC treated with TAE from 1/2014 to 6/2022. The patients underwent initial baseline contrast-enhanced cross-sectional imaging more than 30 days prior to embolization. Index tumors were defined as the largest HCC present on baseline imaging treated with TAE, and TVDT was calculated using Schwartz’s equation with perpendicular trans-axial measurements. Genetic mutation analysis was performed on HCC tissue specimens using next-generation sequencing. Survival analysis was performed using the Kaplan–Meier method, and Cox regression was used to assess prognostic factors for survival. Results: Patients with a TVDT ≤ 2.5 months had a worse overall survival (OS) after TAE (p= 0.011). On multivariate regression analysis, predictors of worse OS following TAE included TVDT ≤ 2.5 months (p= 0.036), Eastern Cooperative Oncology Group (ECOG) performance score of 1 or 2 (p= 0.006), and alpha fetoprotein > 200 ng/mL (p= 0.013). The presence of ≥5 HCC tumors on initial imaging was associated with a worse local tumor progression-free survival (LTPFS) on multivariate analysis (p= 0.002). No single genetic mutation was associated with shorter TVDT. Conclusion: Patients with HCC exhibiting rapid growth, defined as shorter TVDT, may be associated with worse overall survival following TAE. Rapid tumor growth does not seem to be correlated with a single genetic mutation.
目的：本研究旨在探讨肝细胞癌（HCC）患者经动脉栓塞术（TAE）治疗后，肿瘤体积倍增时间（TVDT）与临床结局之间的关联，并评估肿瘤基因型对TVDT的影响。方法：本研究为一项在单一三级癌症中心进行的回顾性队列研究，纳入2014年1月至2022年6月期间经活检证实、既往未接受过治疗并接受TAE治疗的HCC患者。患者在栓塞前30天以上接受了首次基线增强横断面影像学检查。将基线影像中经TAE治疗的最大HCC定义为指标肿瘤，并采用Schwartz方程结合垂直横轴测量值计算TVDT。利用新一代测序技术对HCC组织标本进行基因突变分析。采用Kaplan-Meier法进行生存分析，并使用Cox回归评估生存的预后因素。结果：TVDT ≤ 2.5个月的患者在TAE治疗后总生存期（OS）更差（p=0.011）。多变量回归分析显示，TAE术后OS较差的预测因素包括：TVDT ≤ 2.5个月（p=0.036）、东部肿瘤协作组（ECOG）体能状态评分为1或2分（p=0.006）以及甲胎蛋白 > 200 ng/mL（p=0.013）。多变量分析表明，初始影像学检查显示存在≥5个HCC肿瘤与较差的局部肿瘤无进展生存期（LTPFS）相关（p=0.002）。未发现单一基因突变与较短的TVDT相关。结论：表现为快速生长（即TVDT较短）的HCC患者，在TAE治疗后可能总生存期更差。肿瘤快速生长似乎与单一基因突变无关。
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