Casadei-Gardini Andrea, Dadduzio Vincenzo, Rovesti Giulia, Cabibbo Giuseppe, Vukotic Ranka, Rizzato Mario Domenico, Orsi Giulia, Rossi Margherita, Guarneri Valeria, Lonardi Sara, D'agostino Dario, Celsa Ciro, Andreone Pietro, Zagonel Vittorina, Scartozzi Mario, Cascinu Stefano, Cucchetti Alessandro
Unit of Oncology, Department of Oncology, University Hospital of Modena and Reggio Emilia, Modena.
Medical Oncology Unit 1, Istituto Oncologico Veneto IRCCS, Padova.
Medicine (Baltimore). 2020 May 29;99(22):e19958. doi: 10.1097/MD.0000000000019958.
Sorafenib is the first multikinase inhibitor demonstrating a survival benefit for patients suffering from advanced hepatocellular carcinoma (HCC). However, 1 issue remains open: what is the factor able to predict which patients will be long survivors?In the present study, we harnessed the potential of conditional survival, aiming at estimating the probability that a patient receiving sorafenib survives for more than 3 years.The present multicentric study was conducted on a cohort of 438 HCC patients. The primary end point was conditional overall survival. Kaplan-Meier survival analysis was used to calculate conditional overall survival probabilities at 3 years.The 3-year conditional survival of patients without disease progression highlights that NLR and ECOG are the factors that most accurately predict the probability of long survival. The 3-year conditional survival of patients with disease progression showed a medium effect size for HCV status, alpha-fetoprotein and NLR at all time-points. Macro-vascular portal vein invasion, extra hepatic disease, and BCLC we have a large effect size at 6 months and a medium effect size at 12 and 24 months.Our findings support the use of baseline NLR for the identification of patients with a higher probability of long-survival. NLR should be used as a stratification factor in the forthcoming clinical trials on the drugs for the advanced HCC now in pipeline.
索拉非尼是首个对晚期肝细胞癌（HCC）患者显示出生存获益的多激酶抑制剂。然而，有一个问题仍未解决：能够预测哪些患者会长期存活的因素是什么？在本研究中，我们利用了条件生存的潜力，旨在估计接受索拉非尼治疗的患者存活超过3年的概率。本多中心研究对438例HCC患者进行了队列研究。主要终点是条件总生存。采用Kaplan-Meier生存分析计算3年时的条件总生存概率。无疾病进展患者的3年条件生存表明，中性粒细胞与淋巴细胞比值（NLR）和美国东部肿瘤协作组（ECOG）体能状态评分是最准确预测长期生存概率的因素。有疾病进展患者的3年条件生存显示，丙型肝炎病毒（HCV）状态、甲胎蛋白和NLR在所有时间点均显示中等效应量。大血管门静脉侵犯、肝外疾病和巴塞罗那临床肝癌（BCLC）分期在6个月时显示大效应量，在12个月和24个月时显示中等效应量。我们的研究结果支持使用基线NLR来识别长期生存概率较高的患者。在即将开展的针对晚期HCC药物的临床试验中，NLR应作为分层因素。
