Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Cancer Res Treat. 2010 Dec;42(4):203-9. doi: 10.4143/crt.2010.42.4.203. Epub 2010 Dec 31.
Systemic chemotherapy is the only option for patients with unresectable/metastatic hepatocellular carcinoma (HCC) who are not candidates for local/regional treatment. However, the response to such treatment and survival are poor, especially in hepatitis B virus (HBV) endemic areas. The aim of this study was to determine the efficacy of cisplatin-based combination chemotherapy and identify a subgroup of advanced HCC patients with favorable responses.
The medical records of all consecutive patients with unresectable/metastatic HCC who received cisplatin-based combination chemotherapy between January 2003 and October 2009 were reviewed. Time to progression (TTP) and overall survival (OS) were determined using Kaplan-Meier analysis. Univariate and multivariate analyses were performed to identify prognostic factors for TTP and OS.
Data for 46 patients were analyzed. First-line chemotherapies consisted of cisplatin-based combination treatment with doxorubicin, fluoropyrimidines and gemcitabine. The response rate for all patients was 4.3%. The median TTP and OS were 1.8 (95%confidence interval [CI], 1.1 to 2.5) and 7.2 (95% CI, 3.0 to 11.5) months, respectively. Eastern Cooperative Oncology Group (ECOG) performance status (PS), Child classification, Cancer of the Liver Italian Program (CLIP) score and portal vein thrombosis (PVT) were identified by univariate analyses as prognostic factors for TTP and OS. ECOG PS (hazard ratio [HR], 4.51; 95% CI, 1.61 to 12.6; p=0.004) and PVT (HR, 2.12; 95% CI, 1.10 to 4.11; p=0.026) were independent prognostic factors for TTP.
Cisplatin-based combination chemotherapy in patients with advanced HCC has a low response rate and short TTP regardless of the chemotherapy regimen used. Patients with a good ECOG PS and without PVT can be considered candidates for cisplatin-based combination chemotherapy.
对于不适合局部/区域治疗的不可切除/转移性肝细胞癌（HCC）患者，全身化疗是唯一选择。然而，这种治疗的反应和生存率都很差，特别是在乙型肝炎病毒（HBV）流行地区。本研究旨在确定基于顺铂的联合化疗的疗效，并确定对晚期 HCC 患者有良好反应的亚组。
回顾了 2003 年 1 月至 2009 年 10 月期间接受基于顺铂的联合化疗的不可切除/转移性 HCC 连续患者的病历。使用 Kaplan-Meier 分析确定无进展生存期（TTP）和总生存期（OS）。进行单因素和多因素分析以确定 TTP 和 OS 的预后因素。
对 46 例患者的数据进行了分析。一线化疗包括顺铂联合多柔比星、氟嘧啶和吉西他滨。所有患者的缓解率为 4.3%。中位 TTP 和 OS 分别为 1.8（95%置信区间 [CI]，1.1 至 2.5）和 7.2（95%CI，3.0 至 11.5）个月。东部合作肿瘤学组（ECOG）表现状态（PS）、Child 分类、意大利肝癌计划（CLIP）评分和门静脉血栓形成（PVT）通过单因素分析被确定为 TTP 和 OS 的预后因素。ECOG PS（风险比 [HR]，4.51；95%CI，1.61 至 12.6；p=0.004）和 PVT（HR，2.12；95%CI，1.10 至 4.11；p=0.026）是 TTP 的独立预后因素。
基于顺铂的联合化疗在晚期 HCC 患者中的反应率低且 TTP 短，无论使用何种化疗方案。ECOG PS 良好且无 PVT 的患者可被视为基于顺铂的联合化疗的候选者。
