Subclassification of patients with intermediate-stage (Barcelona Clinic Liver Cancer stage-B) hepatocellular carcinoma using the up-to-seven criteria and serum tumor markers
Subclassification of patients with intermediate-stage (Barcelona Clinic Liver Cancer stage-B) hepatocellular carcinoma using the up-to-seven criteria and serum tumor markers
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DOI：
10.1007/s12072-016-9771-0
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发表时间：
2017-01-01
影响因子：
6.6
通讯作者：
Katayama, Kazuhiro
中科院分区：
文献类型：
--
作者：
Kimura, Haruki;Ohkawa, Kazuyoshi;Katayama, Kazuhiro
中期[巴塞罗那临床肝癌 B 期 (BCLC-B)] 肝细胞癌 (HCC) 由具有多种肿瘤负荷的异质患者群体组成。因此，我们根据这些患者的回顾性分析结果，使用多达七项标准和肿瘤标志物制定了 BCLC-B HCC 亚分类。本研究纳入了 125 名新诊断为 BCLC-B HCC 并接受经动脉化疗栓塞的患者。其中，符合七项标准的有39家，超出七项标准的有86家。进行多变量 Cox 比例风险分析，以调查与标准相关的有助于更好预后的因素。与超出 7 个标准的患者相比，符合最多 7 个标准的患者的累积总生存率 (OS) 和无病生存率显着更高（分别为 p = 0.034 和 p = 0.001）。多变量分析显示，低浓度的脱γ-羧基凝血酶原 (DCP) (< 150 mAU/ml) 和甲胎蛋白 (AFP) (< 100 ng/ml) 分别是达到或超过七项标准的患者更好 OS 的独立因素。因此，将患者分类如下：A组（DCP<150mAU/ml，符合最多7个标准的患者），C组（AFP ae100ng/ml，超出最多7个标准的患者），B组（其他患者）。各组间 OS 差异显着 (p < 0.001)，A、B 和 C 组的中位生存时间分别为 4.2、2.7 和 1.5 年。包含最多 7 个标准的亚分类系统结合 DCP 和 AFP 水平可以作为更好的预后预测指标，从而指导改进治疗策略。
Intermediate-stage [Barcelona Clinic Liver Cancer stage-B (BCLC-B)] hepatocellular carcinoma (HCC) comprises of a heterogeneous population of patients with a wide range of tumor burdens. We therefore formulated a subclassification of BCLC-B HCC using the up-to-seven criteria and tumor markers according to the results of a retrospective analysis of these patients.This study included 125 patients newly diagnosed with BCLC-B HCC who underwent transarterial chemoembolization. Among them, 39 and 86 were within or beyond the up-to-seven criteria, respectively. Multivariate Cox proportional hazards analysis was performed to investigate factors that contributed to better prognosis associated with the criteria.Cumulative overall survival (OS) and disease-free survival rates were significantly higher for patients within the up-to-seven criteria compared with those beyond (p = 0.034 and p = 0.001, respectively). Multivariate analysis revealed that low concentrations of des-gamma-carboxy prothrombin (DCP) (< 150 mAU/ml) and alpha-fetoprotein (AFP) (< 100 ng/ml) were independent contributors to better OS of patients within or beyond the up-to-seven criteria, respectively. Accordingly, the patients were classified as follows: group A (patients within the up-to-seven criteria with DCP < 150 mAU/ml), group C (patients beyond the up-to-seven criteria with AFP ae100 ng/ml), and group B (other patients). OS differed significantly among groups (p < 0.001), and the median survival times of group A, B, and C were 4.2, 2.7, and 1.5 years, respectively.The subclassification system incorporating the up-to-seven criteria combined with DCP and AFP levels may serve as better predictors of prognosis that may guide efforts to improve treatment strategies.