Section of Health Services Research, Houston Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA.
J Clin Gastroenterol. 2012 Jan;46(1):71-7. doi: 10.1097/MCG.0b013e318224d669.
To evaluate the utilization and determinants of receiving palliative treatment for hepatocellular carcinoma (HCC), and its effect on survival.
Palliative treatment for HCC, including transarterial chemoembolization (TACE) and systemic chemotherapy, is available for patients who do not receive potentially curative therapy. The utilization and outcomes of these therapies in clinical practice are unknown.
We conducted a population-based cohort study using the Surveillance, Epidemiology, and End-Results Registry data linked to Medicare claims of HCC patients aged above 65 years diagnosed during 2000 to 2005 who did not receive liver transplant, resection, or ablation. The proportions of patients who received TACE or systemic chemotherapy were calculated by tumor stage, liver disease status, and non-HCC comorbidity. Determinants of receiving palliative therapy were examined in logistic regression models and propensity scores were calculated. Cox proportional hazards models were used to evaluate mortality risk.
We identified 3163 HCC patients (median age, 75 y; 67% men) who did not receive potentially curative treatment. Approximately 12.5% of patients received TACE and 11.0% received chemotherapy. In patients with early or intermediate stage HCC, no liver decompensation, and little or no comorbidity, only 22.8% received TACE and 13.8% received chemotherapy. Median survival was significantly higher among patients who received TACE (14.0 mo) compared with who received chemotherapy (5.0 mo) or no therapy (2.0 mo). A significant reduction in overall mortality was observed for TACE (54%) and chemotherapy (33%).
Utilization of palliative treatment for HCC is low, which could not be explained by clinical features. However, misclassification could have occurred due to the data source. Receipt of TACE or systemic chemotherapy was associated with a reduction in mortality.
评估肝细胞癌（HCC）姑息治疗的应用情况和决定因素及其对生存率的影响。
对于未接受潜在根治性治疗的 HCC 患者，可提供姑息治疗，包括经动脉化疗栓塞（TACE）和全身化疗。这些疗法在临床实践中的应用情况和结果尚不清楚。
我们利用 Surveillance, Epidemiology, and End-Results 登记处的数据进行了一项基于人群的队列研究，这些数据与 Medicare 索赔记录相关联，纳入了 2000 年至 2005 年间诊断为 HCC 且年龄超过 65 岁、未接受肝移植、切除术或消融术的患者。根据肿瘤分期、肝病状况和非 HCC 合并症计算接受 TACE 或全身化疗的患者比例。采用 logistic 回归模型分析接受姑息治疗的决定因素，并计算倾向评分。采用 Cox 比例风险模型评估死亡率风险。
我们共确定了 3163 例未接受潜在根治性治疗的 HCC 患者（中位年龄 75 岁；67%为男性）。约 12.5%的患者接受了 TACE，11.0%的患者接受了化疗。在早期或中期 HCC 患者中，如果没有肝失代偿且合并症较少或没有，则只有 22.8%的患者接受了 TACE，13.8%的患者接受了化疗。与接受化疗（5.0 个月）或未接受治疗（2.0 个月）的患者相比，接受 TACE 治疗的患者中位生存期显著更长（14.0 个月）。TACE（54%）和化疗（33%）均可显著降低总死亡率。
HCC 姑息治疗的应用率较低，这不能用临床特征来解释。然而，由于数据源的原因，可能存在分类错误。接受 TACE 或全身化疗与死亡率降低相关。
