Hemorrhagic events in hepatocellular carcinoma patients treated with antiangiogenic therapies.
Hemorrhagic events in hepatocellular carcinoma patients treated with antiangiogenic therapies.
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DOI：
10.1002/hep.26120
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发表时间：
2013-03
期刊：
影响因子：
13.5
通讯作者：
Greten, Tim F.
中科院分区：
文献类型：
--
作者：
Duffy, Austin;Wilkerson, Julia;Greten, Tim F.
肝硬化的存在增加了肝细胞癌（HCC）患者出血的潜在风险。我们评估了接受抗血管生成药物治疗的HCC患者出血的相对风险。我们对1995年至2011年HCC抗血管生成研究进行了系统回顾和荟萃分析。对于非随机研究，我们将出血风险与其他不包括抗血管生成药物的HCC单组研究进行了比较。为了分离疾病特异性因素，我们还与评估索拉非尼的肾癌研究进行了比较分析。与对照组相比，索拉非尼与所有级别出血事件的出血风险增加相关（OR 1.77; 95% CI 1.04，3.0），但在HCC和RCC中与3-5级事件无关（OR 1.46，95% CI 0.9，2.36 [p=0.45]）。在评价抗血管生成药物的单组II期研究中比较出血风险时，所有事件的风险（OR 4.34; 95% CI 2.16，8.73）均高于对照组。对随机和非随机研究的分析评估了HCC中的抗血管生成剂，结果显示，虽然索拉非尼的使用与HCC中出血风险增加相关，但这主要是低级别事件，与RCC中遇到的风险程度相似。
The presence of cirrhosis increases the potential risk of hemorrhage for patients with hepatocellular carcinoma (HCC). We evaluated the relative risk for hemorrhage in patients with HCC treated with anti-angiogenic agents. We performed a systematic review and meta-analysis of anti-angiogenic studies in HCC from 1995 to 2011. For non-randomized studies we compared bleeding risk with other HCC single-arm studies which did not include an anti-angiogenic agent. To separate disease-specific factors we also performed a comparison analysis with renal cancer studies which evaluated sorafenib. Sorafenib was associated with increased bleeding risk compared to control for all grade bleeding events (OR 1.77; 95% CI 1.04, 3.0) but not grade 3–5 events in both HCC and RCC ((OR1.46 95% CI 0.9, 2.36 [p=0.45]). When comparing the risk of bleeding in single-arm phase 2 studies evaluating anti-angiogenic agents, this risk for all events (OR 4.34; 95% CI 2.16, 8.73) was increased compared to control. This analysis of both randomized and non-randomized studies evaluating an anti-angiogenic agent in HCC showed that whilst the use of sorafenib was associated with an increased risk of bleeding in HCC, this was primarily for lower grade events and similar in magnitude to the risk encountered in RCC.
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