Database analysis of patients with hepatocellular carcinoma and treatment flow in early and advanced stages
Database analysis of patients with hepatocellular carcinoma and treatment flow in early and advanced stages
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DOI：
10.1002/prp2.486
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发表时间：
2019-08-01
影响因子：
2.6
通讯作者：
Aoshima, Ken
中科院分区：
文献类型：
--
作者：
Akada, Keishi;Koyama, Noriyuki;Aoshima, Ken
尽管近年来在治疗方式和诊断方面取得了进展，但晚期肝细胞癌（HCC）的预后仍不令人满意。为了深入了解肝癌患者的治疗决策，研究了他们在早期和晚期阶段的特征和治疗流程。使用日本医疗索赔数据库回顾性分析HCC患者的特征和治疗流程。8999例患者诊断为HCC时的平均年龄为71.1岁，早期（I/II期）和晚期（III/IV期）之间没有差异。平均观察时间为26.2个月，晚期比早期短。52.0%的HCC患者报告了HCV肝炎，53.4%伴有高血压，45.8%伴有2型糖尿病，39.3%伴有肝硬化，15.5%伴有高脂血症。HCV肝炎、高血压和高脂血症的发生率随着分期的进展而降低。治疗流程分析显示，在所有疾病阶段，经导管动脉化疗栓塞（TACE）是最常见的一线至四线治疗。表柔比星是最常用于一线TACE的化疗药物（44.1%），其次是米铂（23.6%）和顺铂（12.3%）。随着分期进展，顺铂的使用增加。索拉非尼在3.2%的患者中伴随用于一线TACE，其使用在晚期显著增加。早期和晚期之间的基线特征和治疗流程有明显差异。对数据库的持续分析和更长时间的随访可以提供有关治疗选择和预后预测（如生存率）的有用信息。
Despite recent developments in treatment modalities and diagnosis, the prognosis of advanced hepatocellular carcinoma (HCC) remains unsatisfactory. To gain insight into treatment decisions for HCC patients, their characteristics and treatment flow in the early and advanced stages were examined. HCC patients' characteristics and treatment flow were retrospectively analyzed using the Japanese medical claims database. The 8999 patients' mean age at HCC diagnosis was 71.1 years, with no difference between early (Stage I/II) and advanced (Stage III/IV) stages. The mean observation period was 26.2 months, shorter in advanced than in early stages. HCV hepatitis was reported in 52.0% of HCC patients, with concomitant hypertension in 53.4%, type 2 diabetes in 45.8%, cirrhosis in 39.3%, and hyperlipidemia in 15.5%. The rates of HCV hepatitis, hypertension, and hyperlipidemia decreased with stage progression. Analysis of treatment flow showed that, at all disease stages, transcatheter arterial chemoembolization (TACE) was the most common first to fourth-line treatment. Epirubicin was the most frequently (44.1%) used chemotherapeutic agent for first-line TACE, followed by miriplatin (23.6%) and cisplatin (12.3%). With stage progression, cisplatin use increased. Sorafenib was used concomitantly for first-line TACE in 3.2% of patients, and its use increased significantly in advanced stages. Clear differences in baseline characteristics and treatment flow between early and advanced stages were identified. Continuous analysis of the database with longer follow-up may provide useful information about treatment selection and prediction of outcome such as survival.