de la Torre Manuel A, Buades-Mateu Juan, de la Rosa Pedro A, Lué Alberto, Bustamante Francisco J, Serrano María T, Testillano Milagros, Lorente Sara, Arenas Juan I, Gil Cristina, Iñarrairaegui Mercedes, Sangro Bruno
Liver Unit, Clínica Universidad de Navarra, Pamplona, Spain.
Preventive Medicine, Complejo Hospitalario de Navarra, Pamplona, Spain.
Liver Int. 2016 Aug;36(8):1206-12. doi: 10.1111/liv.13098. Epub 2016 Mar 23.
BACKGROUND & AIMS: Sorafenib (SOR) is the standard of care for patients with hepatocellular carcinoma (HCC) and portal vein invasion (PVI), based on the results of phase 3 trials. However, radioembolization (RE) using yttrium-90 microspheres has been shown to achieve higher response rates and better survival in large cohorts and phase 2 trials. This study aimed to compare survival of HCC patients with PVI treated by RE or SOR.
Survival among patients with HCC and PVI treated with RE or SOR in four Spanish hospitals between 2005 and 2013 was analysed retrospectively. Kaplan-Meier survival curves were plotted and baseline variables tested for prognostic value using the log-rank test. A multivariate prognostic model including variables identified in the univariate analysis and adjusted by a propensity score based on factors that may determine the probability of exposure to RE was generated using Cox regression analyses.
After a median follow-up of 6 months, 60 deaths had occurred: 38 and 22 in SOR and RE groups respectively. Median survival was 6.7 months (95%CI 5.2-8.1 months) for the entire cohort, and 8.8 months (95%CI 1.8-15.8) in the RE group and 5.4 months (95%CI 2.7-8.1) in the SOR group (P = 0.047). The difference in survival was still statistically significant when 13 patients in the RE group who started SOR after a median time of 8 months were censored from the analysis.
In a cohort of patients with HCC and PVI treatment with RE was associated with a more prolonged survival compared with SOR.
基于3期试验结果，索拉非尼（SOR）是肝细胞癌（HCC）伴门静脉侵犯（PVI）患者的标准治疗方案。然而，在大型队列研究和2期试验中，使用钇-90微球的放射性栓塞（RE）已显示出更高的缓解率和更好的生存率。本研究旨在比较接受RE或SOR治疗的HCC伴PVI患者的生存率。
回顾性分析2005年至2013年在四家西班牙医院接受RE或SOR治疗的HCC伴PVI患者的生存情况。绘制Kaplan-Meier生存曲线，并使用对数秩检验对基线变量的预后价值进行检验。使用Cox回归分析生成一个多变量预后模型，该模型包括单变量分析中确定的变量，并根据可能决定接受RE治疗概率的因素通过倾向评分进行调整。
中位随访6个月后，发生了60例死亡：SOR组和RE组分别为38例和22例。整个队列的中位生存期为6.7个月（95%CI 5.2 - 8.1个月），RE组为8.8个月（95%CI 1.8 - 15.8），SOR组为5.4个月（95%CI 2.7 - 8.1）（P = 0.047）。当从分析中剔除RE组中在中位时间8个月后开始使用SOR的13例患者时，生存差异仍具有统计学意义。
在一组HCC伴PVI患者中，与SOR相比，RE治疗与更长的生存期相关。
