Prognosis of Untreated Hepatocellular Carcinoma
Prognosis of Untreated Hepatocellular Carcinoma
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DOI：
10.1002/hep.27443
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发表时间：
2015-01-01
期刊：
影响因子：
13.5
通讯作者：
Trevisani, Franco
中科院分区：
文献类型：
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作者：
Giannini, Edoardo G.;Farinati, Fabio;Trevisani, Franco
未经治疗的肝细胞癌（HCC）患者的预后是异质性的，生存数据主要来自随机研究的对照组。迫切需要关于这一主题的临床实践数据，以帮助规划研究和为患者提供咨询。我们评估了600例未经治疗的HCC患者的预后，这些患者由意大利肝癌组织管理。根据巴塞罗那临床肝癌（BCLC）分类，通过细分患者来评估预后。我们还评估了晚期HCC患者亚组（BCLC C）的主要人口统计学、临床和肿瘤学生存决定因素。晚期（BCLC C：n=138; 23.0%）和终末期HCC（BCLC D; n=210; 35.0%）代表了大多数患者。总体中位生存期为9个月，主要死亡原因为肿瘤进展（n=279; 46.5%）。随着BCLC分期的恶化，患者的中位生存期进行性显著降低（BCLC 0：38个月; BCLC A：25个月; BCLC B：10个月; BCLC C：7个月; BCLC D：6个月; P3）HCC（HR=1.79; 95% CI=1.21-2.63; P=0.003）是晚期HCC（BCLC C）患者生存期的独立预测因素。结论：BCLC可充分预测未经治疗的HCC患者的预后。在未经治疗的晚期HCC患者中，女性、肝硬化的临床失代偿和多结节肿瘤是独立的预后预测因素，在未来的治疗研究中应考虑患者分层。（肝病学2015;61：184-190）
The prognosis of untreated patients with hepatocellular carcinoma (HCC) is heterogeneous, and survival data were mainly obtained from control arms of randomized studies. Clinical practice data on this topic are urgently needed, so as to help plan studies and counsel patients. We assessed the prognosis of 600 untreated patients with HCC managed by the Italian Liver Cancer Group. Prognosis was evaluated by subdividing patients according to the Barcelona Clinic Liver Cancer (BCLC) classification. We also assessed the main demographic, clinical, and oncological determinants of survival in the subgroup of patients with advanced HCC (BCLC C). Advanced (BCLC C: n=138; 23.0%) and end-stage HCC (BCLC D; n=210; 35.0%) represented the majority of patients. Overall median survival was 9 months, and the principal cause of death was tumor progression (n=279; 46.5%). Patients' median survival progressively and significantly decreased as BCLC stage worsened (BCLC 0: 38 months; BCLC A: 25 months; BCLC B: 10 months; BCLC C: 7 months; BCLC D: 6 months; P3) HCC (HR=1.79; 95% CI=1.21-2.63; P=0.003) were independent predictors of survival in patients with advanced HCC (BCLC C). Conclusion: BCLC adequately predicts the prognosis of untreated HCC patients. In untreated patients with advanced HCC, female gender, clinical decompensation of cirrhosis, and multinodular tumor are independent prognostic predictors and should be taken into account for patient stratification in future therapeutic studies. (Hepatology 2015;61:184-190)