Sethasine Supatsri, Simasingha Nitipon, Ratana-Amornpin Sarita, Mahachai Varocha
Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Center of Excellence in Digestive diseases and Gastroenterology Unit, Department of Medicine, Thammasat University, Pathumthani, Thailand.
Scand J Gastroenterol. 2023 Jul-Dec;58(10):1153-1158. doi: 10.1080/00365521.2023.2209686. Epub 2023 May 18.
Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death. This study investigated the risk factors, treatment responses and survival outcomes in real-world patients with HCC.
This was a large, retrospective cohort study of patients newly diagnosed with HCC at tertiary referral centers in Thailand between 2011 and 2020. Survival time was defined as the time from the date of HCC diagnosis to the date of death or last follow-up.
A total of 1145 patients with a mean age of 61.4 ± 11.7 years were included. Next, 568 (48.7%), 401 (34.4%) and 167 (15.1%) patients were classified as Child-Pugh score A, B and C, respectively. Over half of the patients (59.0%) were diagnosed with noncurative-stage HCC (BCLC B-D). Patients with Child-Pugh A scores were more likely to be diagnosed with curative-stage HCC (BCLC 0-A) than noncurative stage (67.4% vs. 37.2%, < .001). Patients with curative-stage HCC and Child-Pugh A cirrhosis underwent more liver resections than radiofrequency ablation (RFA) (91.8% vs. 69.7%, < .001). For BCLC 0-A patients with portal hypertension, RFA was selected more frequently than liver resection (52.1% vs. 28.6%, < .001). Patients who received RFA monotherapy tended to experience increased median survival times compared to those who underwent resection (55 vs. 36 months; = .058).
Surveillance programs should be encouraged to detect early-stage HCC, which is suitable for curative treatment improving survival outcomes. RFA may be an appropriate first-line treatment for curative-stage HCC. Sequential multi-modality treatment in the curative stage can achieve favorable 5-year survival.
肝细胞癌（HCC）是癌症相关死亡的第四大主要原因。本研究调查了现实世界中HCC患者的危险因素、治疗反应和生存结果。
这是一项对2011年至2020年期间在泰国三级转诊中心新诊断为HCC的患者进行的大型回顾性队列研究。生存时间定义为从HCC诊断日期到死亡日期或最后一次随访日期的时间。
共纳入1145例患者，平均年龄为61.4±11.7岁。接下来，分别有568例（48.7%）、401例（34.4%）和167例（15.1%）患者被分类为Child-Pugh评分A、B和C级。超过一半的患者（59.0%）被诊断为非治愈期HCC（BCLC B-D期）。Child-Pugh A级评分的患者比非治愈期患者更有可能被诊断为治愈期HCC（BCLC 0-A期）（67.4%对37.2%，P<0.001）。治愈期HCC和Child-Pugh A级肝硬化患者接受肝切除术的比例高于射频消融术（RFA）（91.8%对69.7%，P<0.001）。对于伴有门静脉高压的BCLC 0-A期患者，选择RFA的频率高于肝切除术（52.1%对28.6%，P<0.001）。与接受切除术的患者相比，接受RFA单一疗法的患者中位生存时间有延长趋势（55个月对36个月；P=0.058）。
应鼓励开展监测项目以检测适合进行治愈性治疗从而改善生存结果的早期HCC。RFA可能是治愈期HCC的合适一线治疗方法。治愈期的序贯多模式治疗可实现良好的5年生存率。
