Survival impact of delayed treatment in patients with hepatocellular carcinoma undergoing locoregional therapy: Is there a lead-time bias?
Survival impact of delayed treatment in patients with hepatocellular carcinoma undergoing locoregional therapy: Is there a lead-time bias?
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DOI：
10.1080/00365520600931402
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发表时间：
2007-04-01
影响因子：
1.9
通讯作者：
Lee, Shou-Dong
中科院分区：
文献类型：
--
作者：
Huo, Teh-Ia;Huang, Yi-Hsiang;Lee, Shou-Dong
Objective.许多报告指出积极治疗肝细胞癌（HCC）的重要性，但很少有研究讨论延迟治疗对生存率的影响或考虑提前期偏倚。本研究的目的是调查延迟局部区域治疗HCC患者是否真的缩短了诊断后的生存期。材料和方法。比较了48例治疗延迟的HCC患者和96例年龄和性别匹配的对照组的生存率。所有患者均接受经动脉化疗栓塞或经皮乙醇或乙酸注射治疗HCC。治疗延迟定义为诊断和治疗之间的时间间隔>2个月。结果基线比较显示，治疗延迟的患者在终末期肝病模型中的评分高于未延迟的患者（12.3 +/- 1.8 vs 11.1 +/- 2.5，p = 0.01）。在考克斯多变量模型中，晚期癌症分期（相对风险（RR）：2.66，p = 0.001）、Child-Turcotte-Pugh分级B（RR：3.81，p < 0.001）、肿瘤大小> 5 cm（RR：2.02，p = 0.011）和治疗延迟（RR：2.91，p = 0.001）是独立的不良预后预测因子。在治疗延迟的患者中，30例（63%）患者记录了疾病进展。治疗延迟时间延长（> 3个月）的患者更有可能发生肿瘤进展（p = 0.013）。在考克斯模型中，治疗延迟> 3个月独立预测生存率差（RR：3.67，p = 0.002）。结论.延迟HCC治疗与接受局部治疗的患者的总生存期缩短相关，与导入期偏倚无关。这些患者的治疗延迟超过3个月可能会使长期结局恶化。
Objective. Many reports indicate the importance of active treatment for hepatocellular carcinoma (HCC), but there are few studies available that address the impact of delayed therapy on survival or take the lead-time bias into account. The objective of this study was to investigate whether patients with delayed locoregional therapy for HCC truly have a shortened survival from the time of diagnosis. Material and methods. Survival rates were compared between 48 HCC patients with treatment delay and 96 age- and gender-matched controls without delay. All patients underwent transarterial chemoembolization or percutaneous ethanol or acetic acid injection for HCC. Treatment delay was defined as a >2 months' time interval between diagnosis and treatment. Results. Baseline comparison showed that patients with treatment delay had higher scores in the model for endstage liver disease compared with those of patients without delay (12.3 +/- 1.8 versus 11.1 +/- 2.5, p = 0.01). In the Cox multivariate model, advanced cancer stage (relative risk (RR): 2.66, p = 0.001), Child-Turcotte-Pugh class B (RR: 3.81, p < 0.001), tumor size > 5 cm (RR: 2.02, p = 0.011) and treatment delay (RR: 2.91, p = 0.001) were independent poor prognostic predictors. Among patients with treatment delay, disease progression was registered in 30 (63%) patients. Patients with prolonged treatment delay (> 3 months) were more likely to have tumor progression (p = 0.013). In the Cox model, a treatment delay of > 3 months independently predicted a poor rate of survival (RR: 3.67, p = 0.002). Conclusions. Delayed HCC treatment is linked with shortened overall survival unrelated to the lead-time bias in patients undergoing locoregional therapy. Prolonged treatment delay of more than 3 months in these patients may worsen the long-term outcome.