与历史队列相比，现在改善肝细胞癌的临床管理和结果

StephenW

Improvement of clinical management and outcome in hepatocellular carcinoma nowadays compared with historical cohorts

Schellhaas, Barbara; Strobel, Deike; Stumpf, Miriam; Ganslmayer, Marion; Pfeifer, Lukas; Goertz, Ruediger S.; Neurath, Markus F.; Zopf, Steffen
European Journal of Gastroenterology & Hepatology: December 2018 - Volume 30 - Issue 12 - p 1422–1427
doi: 10.1097/MEG.0000000000001221
Original Articles: Hepatology

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Objectives Therapeutic approaches in the treatment of hepatocellular carcinoma (HCC) depend on tumour stage, liver function and patient comorbidities. The aim of this study was to investigate the influence of tumour stage and therapeutic approach on overall survival in HCC.

Materials and methods Two hundred and fourteen patients with HCC diagnosed between December 2012 and May 2017 were assessed retrospectively for tumour stage [Barcelona Clinic Liver Cancer (BCLC)], liver function (Child–Pugh score), therapeutic approach and outcome (mean survival time). The results were compared to two historical cohorts from our centre diagnosed between 1999 and 2013 and 1988 and 1999, respectively.

Results Nowadays, HCC is diagnosed in earlier tumour stages and with better liver function compared with the historical cohorts (P<0.001). Survival times depend on both BCLC stages and liver function for all therapeutic approaches. The 1-year survival rate in the present cohort was 79.4% compared with 58.6% in the historical cohort.

In terms of BCLC stages, therapeutic approaches followed HCC guidelines in 43.9% of cases.

Whereas the percentage of patients receiving resection or ablation did not change between the historical and the present cohort, there was a tendency towards a decrease in transarterial chemoembolization, with a shift towards selective internal radiotherapy, accompanied by an increase in systemic therapy with sorafenib.

Also, the percentage of patients receiving single instead of multiple therapies was significantly higher in the present cohort compared with the historical cohort (P=0.016). In 62/83 patients receiving single therapy (64.7%), tumour remission was maintained during the period of follow-up.

Conclusion HCC is increasingly being diagnosed in earlier stages, so that single therapy is often sufficient. Besides BCLC stages, therapy in HCC must consider liver function, tumour location, local expertise and patients’ comorbidities and preferences. Further research is needed to evaluate the benefit of early multimodal concepts. Therapeutic approaches in HCC remain individual decisions.
Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

StephenW

与历史队列相比，现在改善肝细胞癌的临床管理和结果

Schellhaas，Barbara; Strobel，Deike; Stumpf，Miriam; Ganslmayer，Marion; Pfeifer，Lukas; Goertz，Ruediger S。; Neurath，Markus F。;佐普夫，斯蒂芬
欧洲胃肠病学和肝病学杂志：2018年12月 - 第30卷 - 第12期 - 第1422-1427页
doi：10.1097 / MEG.0000000000001221
原创文章：肝脏病学

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目的治疗肝细胞癌（HCC）的治疗方法取决于肿瘤分期，肝功能和患者合并症。本研究的目的是研究肿瘤分期和治疗方法对HCC总体生存的影响。

材料和方法回顾性分析2012年12月至2017年5月间诊断为HCC的212例肿瘤患者[巴塞罗那临床肝癌（BCLC）]，肝功能（Child-Pugh评分），治疗方法和结果（平均生存时间） ）。将结果与我们分别于1999年至2013年以及1988年和1999年诊断出的中心的两个历史队列进行比较。

结果目前，与历史队列相比，HCC在早期肿瘤阶段被诊断出并具有更好的肝功能（P <0.001）。生存时间取决于所有治疗方法的BCLC阶段和肝功能。目前队列的1年生存率为79.4％，而历史队列为58.6％。

就BCLC阶段而言，治疗方法遵循HCC指南，占43.9％。

尽管接受切除或消融的患者百分比在历史和当前队列之间没有变化，但是存在经动脉化学栓塞减少的趋势，转向选择性内部放疗，伴随着索拉非尼全身治疗的增加。

此外，与历史队列相比，目前队列中接受单次而非多次治疗的患者百分比显着更高（P = 0.016）。在接受单一治疗的62/83例患者中（64.7％），在随访期间维持肿瘤缓解。

结论HCC越来越多地被诊断为早期阶段，因此单一治疗通常就足够了。除了BCLC阶段，HCC的治疗必须考虑肝功能，肿瘤位置，当地专业知识和患者的合并症和偏好。需要进一步研究以评估早期多模态概念的益处。 HCC的治疗方法仍然是个人决定。
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