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经动脉化疗栓塞在初治性和复发性肝细胞癌患者中的应用: 一项倾向性匹配结果分析-ag捕鱼平台

文字: 2019-11-13    浏览次数:392    

objectivestransarterial chemoembolization (tace) improves the survival of patients with hepatocellular carcinoma (hcc); however, tace treatment outcomes of patients with treatment-naïve hcc (tn-hcc) and those with recurrent hcc after curative resection (r-hcc) have not yet been compared.

目的:经动脉化疗栓塞(tace)可提高肝细胞癌(hcc)患者的生存;然而,尚未有tace治疗初治性肝细胞癌(tn-hcc)与治疗根治性切除术后复发的肝细胞癌(r-hcc)患者疗效的对比研究。

 

methodswe recruited 448 patients with tn-hcc, and 275 patients with r-hcc treated with tace as first-line anti-cancer treatment.

方法:共纳入448tn-hcc患者,275r-hcc患者接受tace一线抗癌治疗。

 

results:at first tace, patients with tn-hcc showed a significantly lower proportion of male gender (74.9% vs. 84.3%), higher proportion of liver cirrhosis (61.9% vs. 49.3%), higher aspartate aminotransferase (median 48 vs. 31 iu/l), alanine aminotransferase (median 38 vs. 26 iu/l), alpha-fetoprotein (afp) (median 96.6 vs. 7.7 ng/ml), and total bilirubin (mean 1.0 vs. 0.8 mg/dl) levels, longer prothrombin time (median 1.05 vs. 1.01 international normalized ratio), higher tumor number (mean 2.1 vs. 1.7), larger tumor size (median 3.1 vs. 1.6 cm), and lower proportion of barcelona clinic liver cancer stage 0-a (55.6% vs. 71.9%) than patients with r-hcc (all p<0.05). multivariate analysis showed that tace for tn-hcc (vs. r-hcc) was an independent predictor of mortality (hazard ratio, 1.328; p=0.024) with afp level and tumor number (all p<0.05). however, treatment outcomes between tn-hcc and r-hcc became statistically similar after propensity score-matched (psm) analysis using liver cirrhosis, tumor size, and multiple tumors (p<0.05).

结果:首次进行tace时,与r-hcc 组相比,tn-hcc组男性性别比例更低(74.9% vs. 84.3%),肝硬化比例更高(61.9% vs. 49.3%),天冬氨酸转氨酶(平均48 vs. 31 iu/l)、丙氨酸转氨酶(平均38 vs. 26 iu/l)、甲胎蛋白(afp)(平均96.6 vs. 7.7 ng/ml)和总胆红素 (平均1.0 vs. 0.8 mg/dl)水平更高,凝血酶原时间(平均1.05 vs. 1.01国际标准化比率)更长,巴塞罗那临床肝癌0-a期患者的肿瘤数更多(平均2.1 vs. 1.7),肿瘤体积更大(平均3.1 vs. 1.6 cm),巴塞罗那临床肝癌0-a期患者比例更低(55.6% vs. 71.9%)(均为p < 0.05)。多因素分析显示,afp水平和肿瘤数(均为p < 0.05)tace治疗tn-hcc (vs. r-hcc)死亡率的独立预测因素(hr, 1.328;p = 0.024)。然而,经肝硬化程度、肿瘤大小和多肿瘤倾向性评分匹配(psm)后,tn-hccr-hcc的治疗结果在统计学上相似(p < 0.05)

 

conclusionsbased on the similar tace treatment outcomes observed with the psm analysis, the current tace treatment guideline for patients with tn-hcc might similarly be applied for patients with r-hcc.

结论:基于psm分析观察到的相似的tace治疗结果显示,目前针对tn-hcc患者的tace治疗指南可能同样适用于r-hcc患者。