Okuyama Hiroyuki, Ikeda Masafumi, Kuwahara Akiko, Takahashi Hideaki, Ohno Izumi, Shimizu Satoshi, Mitsunaga Shuichi, Senda Shoichi, Okusaka Takuji
Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
Oncology. 2015;88(4):241-6. doi: 10.1159/000369351. Epub 2014 Dec 11.
The aim of this study was to identify the prognostic factors in patients with advanced hepatocellular carcinoma (HCC) who are refractory or intolerant to sorafenib and to exclude unsuitable candidates from subsequent therapy.
The study cohort consisted of 111 patients who had discontinued sorafenib therapy. Uni- and multivariate analyses were conducted to identify the prognostic factors for survival after discontinuation of sorafenib therapy.
The median age of the patients was 70 years, and 96 of them (86%) were male. The Eastern Cooperative Oncology Group performance status was 0-1 in 94 patients (85%). Forty patients (36%) were classified as Child-Pugh class A and 57 (51%) as Child-Pugh class B. The median survival time after discontinuation of sorafenib therapy was 146 days. Hepatitis C viral antibody negativity, presence of ascites, absence of a history of previous treatment excluding sorafenib, elevated serum total bilirubin level, and elevated serum α-fetoprotein level were identified as the independent unfavorable prognostic factors by multivariate analysis. The median survival time of the patients with 4 or 5 unfavorable prognostic factors was 59 days.
We should judge the indication of any subsequent therapy carefully in patients with 4 or 5 of the aforementioned factors.
本研究旨在确定对索拉非尼耐药或不耐受的晚期肝细胞癌（HCC）患者的预后因素，并排除后续治疗的不合适人选。
研究队列包括111例已停用索拉非尼治疗的患者。进行单因素和多因素分析以确定停用索拉非尼治疗后生存的预后因素。
患者的中位年龄为70岁，其中96例（86%）为男性。94例患者（85%）的东部肿瘤协作组体能状态为0 - 1。40例患者（36%）被归类为Child-Pugh A级，57例（51%）为Child-Pugh B级。停用索拉非尼治疗后的中位生存时间为146天。多因素分析确定丙型肝炎病毒抗体阴性、存在腹水、无除索拉非尼外的既往治疗史、血清总胆红素水平升高和血清甲胎蛋白水平升高为独立的不良预后因素。具有4个或5个不良预后因素的患者的中位生存时间为59天。
对于具有上述4个或5个因素的患者，我们应谨慎判断任何后续治疗的适应证。
