Treatment choice for early-stage hepatocellular carcinoma in real-world practice: impact of treatment stage migration to transarterial chemoembolization and treatment response on survival
Stuart K. Roberts, Alessia Gazzola, John Lubel, Paul Gow, Sally Bell, Amanda Nicoll, show all
Received 12 Jul 2018, Accepted 22 Aug 2018, Published online: 05 Nov 2018
Objective: The objectives of our study were firstly to characterize the treatment stage migration phenomenon in early (Barcelona Clinic Liver Cancer [BCLC]-0/A) stage hepatocellular carcinoma (HCC) by comparing the efficacy of curative therapies with trans-arterial chemoembolization [TACE] and secondly, determining baseline and on-treatment predictors of survival.
Methods: All patients within BCLC-0/A stage from six tertiary hospitals who received curative therapy with either resection, transplantation, or ablation or TACE as first-line treatment were included in the analyses. The primary endpoint was overall survival; secondary end-points were transplant-free survival and recurrence-free survival.
Results: Between January 2000 and December 2013, we identified 253 BCLC-0/A HCC patients of whom 148 (58.5%) received curative therapy and 105 (41.5%) migrated to TACE. Patients undergoing TACE had lower median survival (2.7 vs. 6.7 years; p < .0001), transplant-free survival (2.6 vs. 4.8 years; p < .0001) and recurrence-free survival (1.3 vs. 2.7 years; p < .001). On multivariate analysis treatment allocation to TACE was an independent prognostic predictor for both lower overall survival (HR 1.70, p = .04) and for HCC recurrence (HR 2.25, p < .001). The main prognostic determinant for each target outcome was Child-Pugh score.
Conclusions: Our study confirms that curative treatments should always be preferred when applicable in early-stage HCC, but that in cases where this is not possible, TACE is a reasonable albeit inferior treatment option. In addition, it provides unique prognostic information on a significant proportion of patients with early-stage disease in whom curative therapy is not applicable.
Keywords: BCLC 0/A, survival, treatment stage migration作者: StephenW 时间: 2018-11-7 17:26
在现实世界实践中对早期肝细胞癌的治疗选择：治疗阶段迁移对经动脉化疗栓塞的影响和治疗对生存的反应
Stuart K. Roberts，Alessia Gazzola，John Lubel，Paul Gow，Sally Bell，Amanda Nicoll，全部显示
2018年7月12日收到，2018年8月22日接受，发布在线：2018年11月5日
结果：2000年1月至2013年12月，我们确定了253名BCLC-0 / A HCC患者，其中148名（58.5％）接受了治疗，105名（41.5％）移植到TACE。接受TACE治疗的患者中位生存期较低（2.7对6.7岁; p <.0001），无移植存活率（2.6对4.8岁; p <.0001）和无复发生存期（1.3对2.7年; p < .001）。在多变量分析中，TACE治疗分配是较低总生存率（HR 1.70，p = .04）和HCC复发（HR 2.25，p <.001）的独立预后预测因子。每个目标结果的主要预后决定因素是Child-Pugh评分。