Hormonal therapy with megestrol in inoperable hepatocellular carcinoma characterized by variant oestrogen receptors
Hormonal therapy with megestrol in inoperable hepatocellular carcinoma characterized by variant oestrogen receptors
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DOI：
10.1054/bjoc.2000.1534
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发表时间：
2001-04-06
影响因子：
8.8
通讯作者：
Manenti, F
中科院分区：
文献类型：
--
作者：
Villa, E;Ferretti, I;Manenti, F
肝细胞癌中变异的肝雌激素受体转录本与侵袭性临床病程和对他莫昔芬无反应性相关。为了评价甲地孕酮（受体后水平的孕激素药物）对生存率和肿瘤生长的影响，我们在一项前瞻性随机研究中招募了45例肝雌激素受体变异的HCC患者，采用甲地孕酮与安慰剂进行比较。通过RT/PCR确定变体雌激素受体的存在。24例患者随机分配至无治疗组，21例患者随机分配至甲地孕酮160 mg/d治疗组（-1）。结果采用Kaplan-Meier法和考克斯法进行分析。以雌激素受体变异为特征的肝细胞癌的生存率极低（中位生存期为7个月）;甲地孕酮显著改善了生存率（18个月）（P = 0.0090）。甲地孕酮治疗患者的肿瘤生长在1年时显著减慢（P = 0.0212）。胆红素水平、门静脉血栓形成、HBV病因和治疗在单变量分析中被确定为与生存显著相关的因素;在多变量分析中，仅甲地孕酮治疗（P = 0.0003）、HBV感染（P = 0.0009）和门静脉血栓形成（P = 0.0051）是与生存独立相关的因素。(1)甲地孕酮可减缓以雌激素受体变异为特征的肝细胞癌患者的侵袭性肿瘤生长，（2）也能有利地影响疾病进程，使中位生存期增加一倍以上。(C)2001年癌症研究运动。
Variant liver oestrogen receptor transcripts in hepatocellular carcinoma are associated with aggressive clinical course and unresponsiveness to tamoxifen. To evaluate the impact on survival and on tumour growth of megestrol (progestin drug acting at post-receptorial level) we enrolled 45 patients with HCC characterized by variant liver oestrogen receptors in a prospective, randomized study with megestrol vs. placebo. Presence of Variant oestrogen receptors was determined by RT/PCR. 24 patients were randomized to no treatment and 21 to therapy with megestrol 160 mg day(-1). Results were analysed by Kaplan-Meier and Cox methods. Survival of hepatocellular carcinoma characterized by variant oestrogen receptors was extremely poor (median survival 7 months); megestrol significantly improved survival (18 months) (P = 0.0090). Tumour growth at one year was significantly slowed down in megestrol-treated patients (P = 0.0212). Bilirubin levels, presence of portal thrombosis, HBV aetiology and treatment were identified at univariate analysis as factors significantly associated with survival; at multivariate analysis, only megestrol therapy (P = 0.0003), presence of HBV infection (P = 0.0009) and presence of portal vein thrombosis (P = 0.0051) were factors independently related with survival. (1) Megestrol slows down the aggressive tumour growth of patients with hepatocellular carcinoma characterized by variant estrogen receptors and (2) is also able to favourably influence the course of disease, more than doubling median survival. (C) 2001 Cancer Research Campaign.