Comparative effectiveness of traditional chemoembolization with or without sorafenib for hepatocellular carcinoma
Comparative effectiveness of traditional chemoembolization with or without sorafenib for hepatocellular carcinoma
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DOI：
10.4254/wjh.v5.i7.364
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发表时间：
2013-07-27
影响因子：
2.4
通讯作者：
Kumar, Ambuj
中科院分区：
文献类型：
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作者：
Muhammad, Adnan;Dhamija, Manish;Kumar, Ambuj
目的：比较经动脉化疗栓塞(TACE) +索拉非尼与单独TACE治疗的不可切除肝细胞癌（HCC）患者的总生存期（OS）和无进展生存期（PFS）及相关不良事件（AE）。方法：在这项回顾性队列研究中，我们收集了2007年至2011年期间所有连续接受TACE +索拉非尼或TACE单独治疗的诊断为不可切除的HCC患者的数据。我们假设联合治疗在提高这些患者的生存率方面优于单独使用TACE。提取的数据包括患者人口统计学、肝病病因学、HCC组织学、终末期肝病模型评分、Child-Turcotte-Pugh （CTP）分类和巴塞罗那临床肝癌（BCLC） HCC分期。计算机断层扫描结果、甲胎蛋白水平、治疗次数和相关AE也被记录和分析。结果：在符合纳入标准的43例患者中，13例接受TACE +索拉非尼治疗，30例单独接受TACE治疗。TACE +索拉非尼组的中位生存期为20.6个月（95%CI: 13.4-38.4），单独TACE组的中位生存期为18.3个月（95%CI: 11.8-32.9） （P = 0.72）。两组间OS （HR = 0.82, 95%CI: 0.38-1.77; P = 0.61）、PFS （HR = 0.93, 95%CI: 0.45-1.89; P = 0.83）和治疗相关毒性（P = 0.554）也无统计学差异。HCC的CTP分型和BCLC分期预测HCC患者的生存有统计学意义（P = 0.001, P = 0.04）。常见的AE有腹痛、恶心、呕吐和轻度肝酶升高。结论：TACE +索拉非尼联合治疗对于不可切除的HCC患者是安全的，并且与TACE单独治疗同样有效。CTP分型和BCLC分期是生存率的重要预测指标。未来需要大量患者的试验来进一步验证这一观察结果。(三)2013年白石登。版权所有。
AIM: To compare the overall survival (OS) and progression-free survival (PFS) with associated adverse events (AE) in patients with unresectable hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) + sorafenib vs TACE alone.METHODS: In this retrospective cohort study we collected data on all consecutive patients with a diagnosis of unresectable HCC between 2007 and 2011 who had been treated with TACE + sorafenib or TACE alone. We hypothesized that the combination therapy is superior to TACE alone in improving the survival in these patients. Data extracted included patient's demographics, etiology of liver disease, histology of HCC, stage of liver disease with respect to model of end stage liver disease score and Child-Turcotte-Pugh (CTP) classification and Barcelona Clinic Liver Cancer (BCLC) staging for HCC. Computed tomography scan findings, alpha fetoprotein levels, number of treatments and related AE were also recorded and analyzed.RESULTS: Of the 43 patients who met inclusion criteria, 13 were treated with TACE + sorafenib and 30 with TACE alone. There was no significant difference in median survival: 20.6 mo (95%CI: 13.4-38.4) for the TACE + sorafenib and 18.3 mo (95%CI: 11.8-32.9) for the TACE alone (P = 0.72). There were also no statistically significant differences between groups in OS (HR = 0.82, 95%CI: 0.38-1.77; P = 0.61), PFS (HR = 0.93, 95%CI: 0.45-1.89; P = 0.83), and treatmentrelated toxicities (P = 0.554). CTP classification and BCLC staging for HCC were statistically significant (P = 0.001, P = 0.04 respectively) in predicting the survival in patients with HCC. The common AE observed were abdominal pain, nausea, vomiting and mild elevation of liver enzymes.CONCLUSION: Combination therapy with TACE + sorafenib is safe and equally effective as TACE alone in patients with unresectable HCC. CTP classification and BCLC staging were the significant predictors of survival. Future trials with large number of patients are needed to further validate this observation. (C) 2013 Baishideng. All rights reserved.