A comparison of survival in patients with hepatocellular carcinoma and portal vein invasion treated by radioembolization or sorafenib
A comparison of survival in patients with hepatocellular carcinoma and portal vein invasion treated by radioembolization or sorafenib
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DOI：
10.1111/liv.13098
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发表时间：
2016-08-01
影响因子：
6.7
通讯作者：
Sangro, Bruno
中科院分区：
文献类型：
--
作者：
de la Torre, Manuel A.;Buades-Mateu, Juan;Sangro, Bruno
背景与目的索拉非尼（SOR）是治疗肝细胞癌（HCC）伴门静脉侵犯（PVI）患者的标准治疗药物，基于3期临床试验的结果。然而，在大型队列和II期试验中，使用钇-90微球的放射性栓塞（RE）已显示出更高的缓解率和更好的生存率。本研究的目的是比较肝癌患者的生存率与肺静脉曲张治疗RE或SOR。MethodsSurvival与肝癌和肺静脉曲张治疗RE或SOR在2005年和2013年之间的四个西班牙医院的患者进行了回顾性分析。绘制Kaplan-Meier生存曲线，并使用对数秩检验检验基线变量的预后价值。一个多变量预后模型，包括在单变量分析中确定的变量和调整的倾向得分的基础上的因素，可能会确定暴露于RE的概率产生使用考克斯回归analysis.ResultsAfter中位随访6个月，60例死亡发生：38和22在SOR和RE组分别。整个队列的中位生存期为6.7个月（95%CI 5.2 - 8.1个月），RE组为8.8个月（95%CI 1.8 - 15.8），SOR组为5.4个月（95%CI 2.7 - 8.1）（P = 0.047）。生存率的差异仍有统计学意义时，13例患者在RE组开始SOR后，中位数时间为8个月被censored从analysis. ConclusionsIn一个队列的HCC和PVI治疗与RE的患者与一个更长的生存期与SOR相比。
Background & AimsSorafenib (SOR) is the standard of care for patients with hepatocellular carcinoma (HCC) and portal vein invasion (PVI), based on the results of phase 3 trials. However, radioembolization (RE) using yttrium-90 microspheres has been shown to achieve higher response rates and better survival in large cohorts and phase 2 trials. This study aimed to compare survival of HCC patients with PVI treated by RE or SOR.MethodsSurvival among patients with HCC and PVI treated with RE or SOR in four Spanish hospitals between 2005 and 2013 was analysed retrospectively. Kaplan-Meier survival curves were plotted and baseline variables tested for prognostic value using the log-rank test. A multivariate prognostic model including variables identified in the univariate analysis and adjusted by a propensity score based on factors that may determine the probability of exposure to RE was generated using Cox regression analyses.ResultsAfter a median follow-up of 6 months, 60 deaths had occurred: 38 and 22 in SOR and RE groups respectively. Median survival was 6.7 months (95%CI 5.2-8.1 months) for the entire cohort, and 8.8 months (95%CI 1.8-15.8) in the RE group and 5.4 months (95%CI 2.7-8.1) in the SOR group (P = 0.047). The difference in survival was still statistically significant when 13 patients in the RE group who started SOR after a median time of 8 months were censored from the analysis.ConclusionsIn a cohort of patients with HCC and PVI treatment with RE was associated with a more prolonged survival compared with SOR.