BCLC-B 亚分期对接受经动脉化疗栓塞治疗的肝细胞癌患者预后能力的评估。

Prognostic ability of BCLC-B Subclassification in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization.

机构信息

Department of Internal Medicine, Fondazione Policlinico Gemelli Catholic University of the Sacred Heart, Rome, Italy.

Division of Gastroenterology, Department of Clinical Medicine, La Sapienza University of Rome, Rome, Italy.

出版信息

Ann Hepatol. 2018 January-February;17(1):110-118. doi: 10.5604/01.3001.0010.7542.

DOI:10.5604/01.3001.0010.7542

PMID:29311396

Abstract

UNLABELLED

Prognostic ability of BCLC-B Subclassification in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization Background and aims. A subclassification system for intermediate hepatocellular carcinoma (HCC) was recently proposed to optimize treatment allocation. The aim of this study was to assess the prognostic ability of that substaging proposal.

PATIENTS AND METHODS

This is a retrospective multicenter cohort study including patients with intermediate HCC treated with transarterial chemoembolization (TACE). Predictors of survival were identified using the Cox proportional regression model.

RESULTS

289 Barcelona Clinic Liver Cancer (BCLC) B patients were included. Median overall survival of the whole cohort was 23 months (C.I. 95% 20.2- 25.8). Child A status (H.R. 1.35, C.I. 95% 1.02-1.78) and tumour burden beyond the up-to-seven criterion (H.R. 1.39, C.I. 95% 1.07- 1.80) were independent prognostic factors for overall survival on multivariate analysis. Analysis of the substages showed that median survival was 33.0 months for B1 stage (n = 81), 20.8 months for B2 stage (n = 106), 16.1 months for B3 stage (n = 24), 22.2 months for B4 stage (n = 42) and 15.0 months for quasi-C stage (n = 36). Regarding the discriminatory ability of the substaging proposal, the log rank test showed a significant survival difference for B1vs. B4 (p = 0.003) and B1 vs. Quasi-C (p = 0.039) and a trend for B1 vs. B2 (p = 0.05) and B1 vs. B3 (p = 0.05).

CONCLUSIONS

Apart from substage B1, BCLC-B subclassification does not discriminate perfectly patients treated with TACE. Also some patients in substage B4 can benefit from TACE.

摘要

目的

最近提出了一种用于中期肝细胞癌（HCC）的亚分期系统，以优化治疗分配。本研究旨在评估该亚分期建议的预后能力。

方法

这是一项回顾性多中心队列研究，纳入了接受经动脉化疗栓塞（TACE）治疗的中期 HCC 患者。使用 Cox 比例风险回归模型确定生存的预测因素。

结果

共纳入 289 例巴塞罗那临床肝癌（BCLC）B 期患者。全队列的中位总生存期为 23 个月（95%CI 20.2-25.8）。Child A 状态（HR 1.35，95%CI 1.02-1.78）和超出 up-to-seven 标准的肿瘤负荷（HR 1.39，95%CI 1.07-1.80）是多变量分析中总生存期的独立预后因素。亚分期分析显示，B1 期的中位生存期为 33.0 个月（n=81），B2 期为 20.8 个月（n=106），B3 期为 16.1 个月（n=24），B4 期为 22.2 个月（n=42），准 C 期为 15.0 个月（n=36）。关于亚分期建议的区分能力，对数秩检验显示 B1 期与 B4 期（p=0.003）和 B1 期与准 C 期（p=0.039）的生存差异有统计学意义，B1 期与 B2 期（p=0.05）和 B1 期与 B3 期（p=0.05）的生存差异有趋势。