Kwon Min Jung, Chang Soy, Kim Ji Hoon, Han Ji Won, Jang Jeong Won, Choi Jong Young, Yoon Seung Kew, Sung Pil Soo
Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Front Oncol. 2023 Mar 22;13:1142661. doi: 10.3389/fonc.2023.1142661. eCollection 2023.
In this study, we examined the natural course of untreated hepatocellular carcinoma (HCC) and identified predictors of survival in an area where hepatitis B is the predominant cause of HCC.
We identified 1,045 patients with HCC who did not receive HCC treatment and were registered in the Korean Primary Liver Cancer Registry between 2008 and 2014, and were followed-up up to December 2018. Thereafter, we analyzed the clinical characteristics of patients who survived for <12 or ≥12 months. A Cox proportional regression model was used to identify the variables associated with patient survival.
The mean age of the untreated patients at HCC diagnosis was 59.6 years, and 52.1% of patients had hepatitis B. Most untreated patients (94.2%) died during the observation period. The median survival times for each Barcelona Clinic Liver Cancer (BCLC) stage were as follows: 31.0 months for stage 0/A (n = 123), 10.0 months for stage B (n = 96), 3.0 months for stage C (n = 599), and 1.0 month for stage D (n = 227). Multivariate Cox regression analysis demonstrated that BCLC stage D (hazard ratio, 4.282; P < 0.001), model for end-stage liver disease (MELD) score ≥10 (HR, 1.484; P < 0.001), and serum alpha-fetoprotein (AFP) level ≥1,000 ng/mL (HR, 1.506; P < 0.001) were associated with poor survival outcomes in patients with untreated HCC. In untreated patients with HCC, advanced stage BCLC, serum AFP level ≥1,000 ng/mL, and MELD score ≥10 were significantly associated with overall survival.
在本研究中，我们调查了未经治疗的肝细胞癌（HCC）的自然病程，并确定了在乙型肝炎是HCC主要病因的地区中生存的预测因素。
我们确定了1045例未接受HCC治疗且在2008年至2014年间登记在韩国原发性肝癌登记处的HCC患者，并随访至2018年12月。此后，我们分析了存活时间<12个月或≥12个月的患者的临床特征。使用Cox比例回归模型来确定与患者生存相关的变量。
未经治疗的患者在HCC诊断时的平均年龄为59.6岁，52.1%的患者患有乙型肝炎。大多数未经治疗的患者（94.2%）在观察期内死亡。每个巴塞罗那临床肝癌（BCLC）分期的中位生存时间如下：0/A期为31.0个月（n = 123），B期为10.0个月（n = 96），C期为3.0个月（n = 599），D期为1.0个月（n = 227）。多变量Cox回归分析表明，BCLC D期（风险比，4.282；P < 0.001）、终末期肝病模型（MELD）评分≥10（HR，1.484；P < 0.001）和血清甲胎蛋白（AFP）水平≥1000 ng/mL（HR，1.506；P < 0.001）与未经治疗的HCC患者的不良生存结果相关。在未经治疗的HCC患者中，晚期BCLC、血清AFP水平≥1000 ng/mL和MELD评分≥10与总生存显著相关。
