趋势改善肝癌预后的临床实践：一个意大利的现场体验

StephenW

Trend of Improving Prognosis of Hepatocellular Carcinoma in Clinical Practice: An Italian In-Field Experience

    Mauro Borzio, Elena Dionigi, Angelo Rossini, Anna Toldi, Giampiero Francica, Fabio Fornari, Andrea Salmi, Fabio Farinati, Susanna Vicari, Massimo Marignani, … show all 13


Abstract
Background

Recent data suggest that outcome of hepatocarcinoma is improving.
Aims

In order to explore whether survival is also increasing in clinical practice, we compared two multicenter independent in-field cohorts of cirrhotics with newly diagnosed HCCs.
Methods

Cohort 1 (C1) consisted of 327 patients enrolled between January and December 1998, and cohort 2 (C2) included 826 patients enrolled between September 2008 and November 2012. Patients were stratified according to Child-Pugh score, MELD score, and HCC staged according to TNM, BCLC systems.
Results

At baseline, C2 patients were significantly older, with more frequent comorbidities and better liver function. In C2, HCC was more frequently detected under regular ultrasound surveillance (P < 0.001), BCLC early stages were more frequent, and rates of smaller and uni/paucinodular tumors were significantly higher. Treatment of any type was more frequently offered to C2 patients (P < 0.001). Proportion of patients treated by TACE increased, and radiofrequency ablation was the most used ablative treatment. Survival rate was significantly higher in C2 being C1 and C2 survival at 1–3 years 72–25 and 75–44 %, respectively. Child-Pugh score A, BCLC stage A, single nodule, size ≤3 cm, belonging to cohort C2 and treatment per se independently predicted survival.
Conclusions

This in-field study showed a trend on improved HCC outcomes over time, which seems to be mainly due to a better presentation thanks to the wider application of surveillance and increased propensity to treat patients. These encouraging data should support further efforts to implement such approach to HCC in everyday clinical practice.

StephenW

趋势改善肝癌预后的临床实践：一个意大利的现场体验

    毛罗Borzio，埃琳娜迪奥尼吉，安杰洛罗西尼，安娜Toldi，詹皮耶罗Francica，法比奥Fornari的，安德烈萨尔米，法比奥Farinati，苏珊娜维卡里，马西莫Marignani，...显示全部13


抽象
背景

最近的数据表明肝癌这一结果正在改善。
目标

为了探讨是否存活也在临床实践中提高，我们比较了两种独立的多中心的现场同伙肝硬化患者初诊肝细胞癌。
方法

第1组（C1）包括了327例患者一月和1998年12月间参加，和队列2（C2），包括826例患者2008年9月和2012年11月入选之间的患者，根据Child-Pugh评分分层，MELD评分，并根据肝癌上演以TNM，BCLC系统。
结果

在基线水平，C2患者显著年长，更频繁的合并症和更好的肝功能。在C2，肝癌被更频繁地定期超声监测检测（P <0.001），BCLC早期阶段更频繁，更小和UNI / paucinodular肿瘤率显著高。的任何类型的治疗更经常提供给C2的患者（p <0.001）。由TACE治疗的患者比例增加，射频消融是最常用的消融治疗。生存率在1 - 3年72-25和75-44％显著高于C2是C1和C2的生存，分别。 Child-Pugh评分A，BCLC A期，单发结节，大小≤3厘米，属于队列C2和治疗本身的独立预测生存。
结论

这在现场研究显示对改善肝癌预后的趋势随着时间的推移，这似乎主要是由于更好的表现得益于广泛应用的监控和倾向增加给病人治病。这些令人鼓舞的数据应该支持进一步的努力来实现这样的方法，以肝癌在日常临床实践。