Nathan Hari, Herlong H Franklin, Gurakar Ahmet, Li Zhiping, Koteish Ayman A, Bridges John F P, Pawlik Timothy M
Division of Surgical Oncology, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Ann Surg Oncol. 2014 Jun;21(6):1844-51. doi: 10.1245/s10434-014-3536-6. Epub 2014 Feb 13.
Choice of therapy in early hepatocellular carcinoma (HCC) is controversial, and no broad consensus exists as to how patient and tumor characteristics should be used to guide choice of therapy. We have previously reported on decision making in early HCC by liver surgeons. In the present study, we quantified the impact of clinical factors on choice of therapy for early HCC by gastroenterologists and hepatologists.
Physicians who treat HCC were invited to complete a web-based survey including ten case scenarios that systematically varied across seven clinical factors. Choice of therapy-liver transplantation (LT), liver resection (LR), radiofrequency ablation or intra-arterial therapy-was analyzed using multinomial logistic regression models.
Tumor number and size, type of resection required, biological Model for End-Stage Liver Disease (MELD) score, and platelet count had the largest effects on choice of therapy. For example, LR was more likely to be recommended over LT for patients with small solitary tumors versus multiple tumors [relative risk ratio (RRR) 3.63], those who would require a minor versus major LR (RRR 3.39), those with lower biological MELD score (6 vs. 10; RRR 1.95), and those with a higher platelet count (150,000/μL vs. 70,000/μL; RRR 2.77). In contrast, serum α-fetoprotein level and etiology of cirrhosis were not associated with choice of therapy. No physician-related factors studied had an impact on choice of therapy.
The clinical factors weighed most heavily by gastroenterologists and hepatologists are quite similar to those considered important by surgeons. There was good consensus among gastroenterologists and hepatologists as to the factors used to choose therapy.
早期肝细胞癌（HCC）的治疗选择存在争议，对于如何利用患者和肿瘤特征来指导治疗选择尚未达成广泛共识。我们之前报道过肝脏外科医生对早期HCC的决策情况。在本研究中，我们对胃肠病学家和肝病学家在早期HCC治疗选择中临床因素的影响进行了量化。
邀请治疗HCC的医生完成一项基于网络的调查，其中包括十个病例场景，这些场景在七个临床因素上系统地有所不同。使用多项逻辑回归模型分析治疗选择——肝移植（LT）、肝切除（LR）、射频消融或动脉内治疗。
肿瘤数量和大小、所需切除类型、终末期肝病生物模型（MELD）评分以及血小板计数对治疗选择的影响最大。例如，对于孤立小肿瘤患者与多肿瘤患者相比[相对风险比（RRR）3.63]、需要进行小范围肝切除与大范围肝切除的患者相比（RRR 3.39）、生物MELD评分较低的患者（6分与10分；RRR 1.95）以及血小板计数较高的患者（150,000/μL与70,000/μL；RRR 2.77），与肝移植相比，更有可能推荐肝切除。相比之下，血清甲胎蛋白水平和肝硬化病因与治疗选择无关。所研究的医生相关因素均未对治疗选择产生影响。
胃肠病学家和肝病学家最为重视的临床因素与外科医生认为重要的因素非常相似。胃肠病学家和肝病学家在用于选择治疗的因素方面达成了良好的共识。
