Using nomogram of the Barcelona Clinic Liver Cancer system for treatment selection in patients with stage C hepatocellular carcinoma.
Using nomogram of the Barcelona Clinic Liver Cancer system for treatment selection in patients with stage C hepatocellular carcinoma.
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DOI：
10.1186/s12885-018-4202-3
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发表时间：
2018-03-14
期刊：
影响因子：
3.8
通讯作者：
Huo TI
中科院分区：
文献类型：
--
作者：
Hsu CY;Liu PH;Ho SY;Hsia CY;Kudaravalli P;Lee YH;Chiou YY;Tsai YJ;Huang YH;Huo TI
巴塞罗那临床肝癌(BCLC)肝细胞癌(HCC)的诺模图已被用于预后预测。在现实生活中，BCLC C期肝癌患者经常违反当前的治疗指南进行抗癌治疗。我们的目的是利用诺模图为BCLC C期患者的治疗选择提供指导。对1317例C期肝细胞癌患者的临床资料进行了回顾性分析，并按诺模点将其分为4组。在接受不同治疗的患者之间，通过组内匹配模型的倾向评分生成一对一的配对。生存分析采用Kaplan-Meier法，采用对数等级检验。诺模点较高的患者更多地接受靶向或支持性治疗(p <； ，0.001)。在所有四组患者中，接受靶向或支持性治疗的患者与接受积极治疗(手术切除、消融、经动脉化疗栓塞术或移植)的患者相比，存活率降低(p <； ，0.001)。在匹配倾向性模型中的基线差异后，接受不同治疗的患者具有相似的年龄、性别、肝病病因、肿瘤负担、肝硬变严重程度和表现状态。再次进行生存分析，发现诺模图得分为 <； 15的患者在积极治疗后总体结果更好(p <； ：0.05)。对于诺模图分数为 >； 15的患者，接受两种不同治疗策略的患者之间的存活率没有显著差异。BCLC系统诺模图是一种可行的工具，可以帮助C期肝癌患者选择初级抗癌治疗，以追求更好的总体生存。
The nomogram of the Barcelona Clinic Liver Cancer (BCLC) for hepatocellular carcinoma (HCC) has been used for outcome prediction. Patients with BCLC stage C HCC often undergo anti-cancer therapy against current treatment guidelines in real world practice. We aimed to use the nomogram to provide guidance on treatment selection for BCLC stage C patients. A total of 1317 patients with stage C HCC were retrospectively analyzed and divided into four groups by nomogram points. One-to-one matched pairs between patients receiving different treatments were generated by the propensity score with matching model within these groups. Survival analysis was performed by Kaplan-Meier method with log-rank test. Patients with higher nomogram points were more often treated with targeted or supportive therapies (p < 0.001). Patients receiving targeted or supportive therapies had a decreased survival compared to patients undergoing aggressive treatments (surgical resection, ablation, transarterial chemo-embolization or transplantation) across all four groups (p < 0.001). After matching for baseline differences in the propensity model, patients receiving different treatments had comparable age, gender, etiology of liver disease, tumor burden, severity of cirrhosis and performance status. Survival analyses were re-performed and disclosed that patients with nomogram points < 15 had better overall outcome after aggressive treatments (p < 0.05). For patients with nomogram points > 15, there was no significant difference in survival between patients receiving two different treatment strategies. The nomogram of BCLC system is a feasible tool to help stage C HCC patients to select primary anti-cancer treatment in pursuance of better overall survival.
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影响因子：
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