Furuse Junji, Shirakawa Sachiyo, Fukui Ayako, Hirai Takehiro, Hamada Yoko, Kitagawa Hiroshi
Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Japan.
Oncology Medical, AstraZeneca K.K., Tokyo, Japan.
Liver Cancer. 2025 Jun 12. doi: 10.1159/000546693.
Transarterial chemoembolization (TACE) is the primary treatment for intermediate-stage hepatocellular carcinoma (HCC). Synergistic effects are expected by adding recently developed systemic therapies onto TACE. We investigated patient and physician preferences for this treatment approach.
Preferences of patients with HCC who underwent TACE and physicians treating HCC were assessed using a discrete choice experiment. Eighteen hypothetical treatment profiles were set based on seven attributes, including survival outcomes, treatment burden, and side effects, with two or three levels. A mixed-logit model estimated the preference weights for each attribute level.
The 85 HCC patients surveyed had a median age of 69 (interquartile range 59-75) years. Most were male (84.7% [72/85]). Most physicians (70.4% [69/98]) were ≥40 years old, and 93.9% (92/98) were male. Both patients and physicians showed the largest positive preferences for 5-year overall survival (OS) {preference weight (95% confidence interval [CI]) 3.41 (2.85, 3.97) and 4.84 (3.90, 5.79), < 0.001, respectively}, relative to 2-year OS. Following this, patients preferred minimizing the risk of fatigue with negative preferences (95% CI) for a 50% risk relative to a 10% risk (-0.84 [-1.24, -0.43], < 0.001), and physicians preferred extended time to progression (TTP) from 6 months to 2 years (1.39 [0.82, 1.95], < 0.001). Physicians, but not patients, exhibited a significant negative preference (95% CI) for a 40% increase in the risk of immune-related side effects (-1.03 [-1.67, -0.39], = 0.002, and -0.41 [-0.84, 0.02], = 0.063, respectively). Preferences varied depending on patient and physician characteristics.
OS was the most important factor for both patients and physicians in TACE-based treatment for HCC, with fatigue the second largest preference factor for patients and TTP for physicians. Understandings of immune-related side effects seemed to vary among participants. These findings enhance patient-physician communication and shared decision-making.
经动脉化疗栓塞术（TACE）是中期肝细胞癌（HCC）的主要治疗方法。在TACE基础上添加最近开发的全身治疗有望产生协同效应。我们调查了患者和医生对这种治疗方法的偏好。
采用离散选择实验评估接受TACE治疗的HCC患者和治疗HCC的医生的偏好。基于包括生存结果、治疗负担和副作用在内的七个属性设置了18种假设治疗方案，每个属性有两个或三个水平。混合逻辑模型估计每个属性水平的偏好权重。
接受调查的85例HCC患者的中位年龄为69岁（四分位间距59 - 75岁）。大多数为男性（84.7%[72/85]）。大多数医生（70.4%[69/98]）年龄≥40岁，93.9%（92/98）为男性。与2年总生存期（OS）相比，患者和医生对5年OS均表现出最大的积极偏好{偏好权重（95%置信区间[CI]）分别为3.41（2.85，3.97）和4.84（3.90，5.79），P<0.001}。在此之后，患者更倾向于将疲劳风险降至最低，相对于10%的风险，50%风险的负偏好（95%CI）为 - 0.84（-1.24，-0.43），P<0.001，而医生更倾向于将疾病进展时间（TTP）从6个月延长至2年（1.39[0.82，1.95]），P<0.001。医生对免疫相关副作用风险增加40%表现出显著的负偏好（95%CI），而患者没有（分别为 - 1.03[-1.67，-0.39]，P = 0.002和 - 0.41[-0.84，0.02]，P = 0.06）。偏好因患者和医生的特征而异。
在基于TACE的HCC治疗中，OS对患者和医生来说都是最重要的因素，疲劳是患者的第二大偏好因素，TTP是医生的第二大偏好因素。参与者对免疫相关副作用的理解似乎存在差异。这些发现有助于加强医患沟通和共同决策。
