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多学科方法与改善肝癌患者的生存率相关。

Multidisciplinary approach is associated with improved survival of hepatocellular carcinoma patients.

机构信息

Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

出版信息

PLoS One. 2019 Jan 14;14(1):e0210730. doi: 10.1371/journal.pone.0210730. eCollection 2019.

Abstract

BACKGROUND

Given the complexity of managing hepatocellular carcinoma (HCC), a multidisciplinary approach (MDT) is recommended to optimize management of HCC patients. However, evidence suggesting that MDT improves patient outcome is limited.

METHODS

We performed a retrospective cohort study of all patients newly-diagnosed with HCC between 2005 and 2013 (n = 6,619). The overall survival (OS) rates between the patients who were and were not managed via MDT were compared in the entire cohort (n = 6,619), and in the exactly matched cohort (n = 1,396).

RESULTS

In the entire cohort, the 5-year survival rate was significantly higher in the patients who were managed via MDT compared to that of the patients who were not (71.2% vs. 49.4%, P < 0.001), with an adjusted hazard ratio (HR) of 0.47 (95% confidence interval [CI]; 0.41-0.53). In the exactly matched cohort, the 5-year survival rate was higher in patients who were managed via MDT (71.4% vs. 58.7%, P < 0.001; HR [95% CI] = 0.67 [0.56-0.80]). The survival benefit of MDT management was observed in most pre-defined subgroups, and was especially significant in patients with poor liver function (ALBI grade 2 or 3), intermediate or advanced tumor stage (BCLC stage B or C), or high alphafetoprotein levels (≥200 ng/ml).

CONCLUSION

MDT management was associated with improved overall survival in HCC patients, indicating that MDT management can be a valuable option to improve outcome of HCC patients. This warrants prospective evaluations.

摘要

背景

鉴于肝细胞癌(HCC)的治疗复杂性,建议采用多学科方法(MDT)来优化 HCC 患者的管理。然而,MDT 可改善患者预后的证据有限。

方法

我们对 2005 年至 2013 年间新诊断为 HCC 的所有患者进行了回顾性队列研究(n=6619)。比较了整个队列(n=6619)和完全匹配队列(n=1396)中通过 MDT 管理和未通过 MDT 管理的患者的总生存率(OS)。

结果

在整个队列中,通过 MDT 管理的患者的 5 年生存率明显高于未通过 MDT 管理的患者(71.2%比 49.4%,P<0.001),调整后的风险比(HR)为 0.47(95%置信区间[CI]:0.41-0.53)。在完全匹配的队列中,通过 MDT 管理的患者的 5 年生存率更高(71.4%比 58.7%,P<0.001;HR[95%CI]=0.67[0.56-0.80])。MDT 管理的生存获益在大多数预先定义的亚组中观察到,在肝功能较差(ALBI 分级 2 或 3)、肿瘤分期中或晚期(BCLC 分期 B 或 C)或高水平甲胎蛋白(≥200ng/ml)的患者中尤其显著。

结论

MDT 管理与 HCC 患者的总体生存率提高相关,表明 MDT 管理是改善 HCC 患者预后的一种有价值的选择。这需要前瞻性评估。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e68d/6331107/819f40795e73/pone.0210730.g001.jpg

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