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标题: 初步治愈后预测早期肝细胞癌长期结果的因素:手术或非手 [打印本页]

作者: StephenW    时间: 2021-3-10 19:00     标题: 初步治愈后预测早期肝细胞癌长期结果的因素:手术或非手

Factors predicting long-term outcomes of early-stage hepatocellular carcinoma after primary curative treatment: the role of surgical or nonsurgical methods
Ming-Jeng Kuo  1 , Lein-Ray Mo  2 , Chi-Ling Chen  3
Affiliations
Affiliations

    1
    Department of Hepatogastroenterology, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan 701, Taiwan. No. 670, Chon-De Road, Tainan, 701, Taiwan. [email protected].
    2
    Department of Hepatogastroenterology, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan 701, Taiwan. No. 670, Chon-De Road, Tainan, 701, Taiwan.
    3
    Graduate Institute of Clinical Medicine, College of Medicine, and Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 100, 7 Chung-Shan South Road, Taipei, 100, Taiwan. [email protected].

    PMID: 33685409 DOI: 10.1186/s12885-021-07948-9

Abstract

Background: We quantified the elusive effects of putative factors on the clinical course of early hepatocellular carcinoma (HCC) after primary surgical or nonsurgical curative treatment.

Methods: Patients with newly diagnosed early HCC who received surgical resection (SR) or percutaneous radiofrequency ablation (RFA) with or without transcatheter arterial chemoembolization (TACE) from January 2003 to December 2016 were enrolled. The cumulative overall survival (OS) and disease-free survival (DFS) rates were compared. A polytomous logistic regression was used to estimate factors for early and late recurrence. Independent predictors of OS were identified using Cox proportional hazard regression.

Results: One hundred twenty-five patients underwent SR, and 176 patients underwent RFA, of whom 72 were treated with TACE followed by RFA. Neither match analysis based on propensity score nor multiple adjustment regression yielded a significant difference in DFS and OS between the two groups. Multivariate analysis showed high AFP (> 20 ng/mL), and multinodularity significantly increased risk of early recurrence (< 1 year). In contrast, hepatitis B virus, hepatitis C virus and multinodularity were significantly associated with late recurrence (> 1 year). Multivariate Cox regression with recurrent events as time-varying covariates identified older age (HR = 1.55, 95% CI:1.01-2.36), clinically significant portal hypertension (CSPH) (HR = 1.97, 95% CI:1.26-3.08), early recurrence (HR = 6.62, 95% CI:3.79-11.6) and late recurrence (HR = 3.75, 95% CI:1.99-7.08) as independent risk factors of mortality. A simple risk score showed fair calibration and discrimination in early HCC patients after primary curative treatment. In the Barcelona Clinic Liver Cancer (BCLC) stage A subgroup, SR significantly improved DFS compared to RFA with or without TACE.

Conclusion: Host and tumor factors rather than the initial treatment modalities determine the outcomes of early HCC after primary curative treatment. Statistical models based on recurrence types can predict early HCC prognosis but further external validation is necessary.

Keywords: Early hepatocellular carcinoma; Prognosis; Propensity score matching; Radiofrequency ablation; Surgical resection; Transcatheter arterial chemoembolization.

作者: StephenW    时间: 2021-3-10 19:00

初步治愈后预测早期肝细胞癌长期结果的因素:手术或非手术方法的作用
郭明正1,莫少雷2,陈志玲3
隶属关系
隶属关系

    1个
    台南市立医院肝肠胃科(由秀泉医疗公司管理),台湾台南701。台湾701台南市春德路670号[email protected]
    2个
    台南市立医院肝肠胃科(由秀泉医疗公司管理),台湾台南701。台湾701台南市春德路670号
    3
    国立台湾大学公共卫生学院临床医学院研究生院,流行病学和预防医学研究所,台北市中山南路7号,台北100,台湾100。 [email protected]

    PMID:33685409 DOI:10.1186 / s12885-021-07948-9

抽象的

背景:我们量化了主要手术或非手术治愈性治疗后推定因素对早期肝细胞癌(HCC)临床病程的难以捉摸的影响。

方法:纳入2003年1月至2016年12月接受手术切除(SR)或经皮射频消融(RFA)或不行经导管动脉化疗栓塞(TACE)的新诊断的早期HCC患者。比较了累积总生存率(OS)和无病生存率(DFS)。多因素logistic回归用于估计早期和晚期复发的因素。使用Cox比例风险回归确定OS的独立预测因子。

结果:125例患者行SR,RFA患者176例,其中72例先后接受TACE和RFA治疗。基于倾向得分的匹配分析或多重调整回归均未在两组之间的DFS和OS上产生显着差异。多变量分析显示高AFP(> 20 ng / mL),多结节明显增加了早期复发(<1年)的风险。相反,乙型肝炎病毒,丙型肝炎病毒和多结节与晚期复发(> 1年)显着相关。随时间变化的协变量的多变量Cox回归确定年龄较大(HR = 1.55,95%CI:1.01-2.36),临床上显着的门脉高压症(CSPH)(HR = 1.97,95%CI:1.26-3.08),早期复发(HR = 6.62,95%CI:3.79-11.6)和晚期复发(HR = 3.75,95%CI:1.99-7.08)是死亡的独立危险因素。一个简单的风险评分显示,早期根治性肝癌患者在早期HCC患者中具有合理的校准和区分度。与带有或不带有TACE的RFA相比,在巴塞罗那临床肝癌(BCLC)A亚组中,SR显着改善了DFS。

结论:宿主和肿瘤因素而不是初始治疗方式决定了初次治愈后早期HCC的结果。基于复发类型的统计模型可以预测HCC的早期预后,但需要进一步的外部验证。

关键词:早期肝细胞癌;预后倾向得分匹配;射频消融;手术切除;经导管动脉化疗栓塞。
作者: StephenW    时间: 2021-3-10 19:00

https://bmccancer.biomedcentral. ... 885-021-07948-9.pdf




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