西部中心肝细胞癌患者的表现和结局。
Presentation and outcomes of hepatocellular carcinoma patients at a western centre.
机构信息
Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
出版信息
HPB (Oxford). 2011 Oct;13(10):712-22. doi: 10.1111/j.1477-2574.2011.00362.x. Epub 2011 Aug 11.
BACKGROUND
The present study examines the presentation and outcomes of hepatocellular carcinoma (HCC) at a Western centre over the last decade.
METHODS
Between January 2000 and September 2009, 1010 patients with HCC were evaluated at the University of Pittsburgh Medical Center (UPMC). Retrospectively, four treatment groups were classified: no treatment (NT), systemic therapy (ST), hepatic artery-based therapy (HAT) and surgical intervention (SI) including radiofrequency ablation, hepatic resection and transplantation. Kaplan-Meier analysis assessed survival between groups. Cox regression analysis identified factors predicting survival.
RESULTS
Patients evaluated were 75% male, 87% Caucasian, 84% cirrhotic, and predominantly diagnosed with hepatitis C. In all, 169 patients (16.5%) received NT, 25 (2.4%) received ST, 529 (51.6%) received HAT and 302 (29.5%) received SI. Median survival was 3.6, 5.6, 8.8, and 83.5 months with NT, ST, HAT and SI, respectively (P= 0.001). Transplantation increased from 9.5% to 14.2% after the model for end-stage liver disease (MELD) criteria granted HCC patients priority points. Survival was unaffected by bridging transplantation with HAT or SI (P= 0.111). On multivariate analysis, treatment modality was a robust predictor of survival after adjusting for age, gender, AFP, Child-Pugh classification and cirrhosis (P < 0.001, χ(2) = 460).
DISCUSSION
Most patients were not surgical candidates and received HAT alone. Surgical intervention, especially transplantation, yields the best survival.
背景
本研究考察了过去十年中西方中心肝细胞癌（HCC）的表现和结局。
方法
在 2000 年 1 月至 2009 年 9 月期间，匹兹堡大学医学中心（UPMC）评估了 1010 例 HCC 患者。回顾性地，将这 1010 例患者分为四个治疗组：无治疗（NT）、系统治疗（ST）、肝动脉治疗（HAT）和手术干预（SI），包括射频消融、肝切除术和肝移植。采用 Kaplan-Meier 分析评估各组之间的生存情况。Cox 回归分析确定了预测生存的因素。
结果
评估的患者中，75%为男性，87%为白种人，84%为肝硬化，主要诊断为丙型肝炎。共有 169 例（16.5%）患者接受 NT，25 例（2.4%）患者接受 ST，529 例（51.6%）患者接受 HAT，302 例（29.5%）患者接受 SI。NT、ST、HAT 和 SI 组的中位生存期分别为 3.6、5.6、8.8 和 83.5 个月（P=0.001）。在模型终末期肝病（MELD）评分给予 HCC 患者优先点后，肝移植从 9.5%增加到 14.2%。HAT 或 SI 桥接移植对生存没有影响（P=0.111）。多变量分析显示，在调整年龄、性别、AFP、Child-Pugh 分级和肝硬化后，治疗方式是生存的有力预测因素（P<0.001，χ(2) = 460）。
讨论
大多数患者不是手术候选者，仅接受 HAT。手术干预，尤其是肝移植，可获得最佳生存。
Zotero 插件