Therapeutic delays lead to worse survival among patients with hepatocellular carcinoma.
Therapeutic delays lead to worse survival among patients with hepatocellular carcinoma.
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治疗延迟导致肝细胞癌患者的生存率较差。
DOI：
10.6004/jnccn.2013.0131
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发表时间：
2013-09-01
期刊：
影响因子：
--
通讯作者：
Yopp AC
中科院分区：
文献类型：
--
作者：
Singal AG;Waljee AK;Patel N;Chen EY;Tiro JA;Marrero JA;Yopp AC
尽管先前的研究表明肝细胞癌（HCC）患者未充分使用适当的治疗，但迄今为止还没有研究评估HCC患者治疗延迟的患病率和临床影响。本研究的目的是描述和确定与这些患者治疗不足和延迟相关的因素。对2005年1月至2012年6月期间在一家大型城市安全网医院诊断为HCC的肝硬化患者进行了一项回顾性队列研究。记录HCC诊断和任何治疗的日期。单因素和多因素分析用于确定与治疗不足和延迟治疗相关的因素，延迟治疗定义为从诊断到治疗的时间超过3个月。作者确定了267例符合治疗条件的HCC患者，其中只有62%接受了HCC治疗。在多变量分析中，肿瘤分期（比值比[OR]，0.48; 95%CI，0.36-0.65）、Child-Pugh分级（OR，0.49; 95%CI，0.28-0.84）和黑人（OR，0.55; 95%CI，0.31-0.99）与较低的治疗使用率相关。中位治疗时间为1.7个月，31%的患者延迟治疗。延迟治疗与腹水（风险比[HR]，2.8; 95% CI，1.3-6.1）和当前经动脉化疗栓塞治疗（HR，4.8; 95% CI，1.8-12.5）相关。在调整肿瘤分期和Child-Pugh分级后，治疗使用不足（HR，0.33; 95% CI，0.24-0.46）和延迟治疗（HR，0.50; 95% CI，0.30-0.84）均与生存率显著降低相关。结果显示，除了三分之一的患者没有接受HCC定向治疗外，另外30%的患者经历了显著的治疗延迟，导致生存率下降。
Although prior studies have shown underuse of appropriate therapy in patients with hepatocellular carcinoma (HCC), no studies to date have assessed the prevalence and clinical impact of therapeutic delays among patients with HCC. The goal of this study was to characterize and identify factors associated with underuse and delays in treatment of these patients. A retrospective cohort study was conducted of patients with cirrhosis diagnosed with HCC at a large urban safety net hospital between January 2005 and June 2012. Dates for HCC diagnosis and any treatments were recorded. Univariate and multivariate analysis was used to determine factors associated with treatment underuse and delayed treatment, which was defined as time from diagnosis to treatment exceeding 3 months. The authors identified 267 treatment-eligible patients with HCC, of whom only 62% received HCC therapy. On multivariate analysis, tumor stage (odds ratio [OR], 0.48; 95% CI, 0.36–0.65), Child-Pugh class (OR, 0.49; 95% CI, 0.28–0.84), and black race (OR, 0.55; 95% CI, 0.31–0.99) were associated with lower rates of treatment use. The median time to treatment was 1.7 months, with 31% of patients experiencing delayed treatment. Delayed treatment was associated with the presence of ascites (hazard ratio [HR], 2.8; 95% CI, 1.3–6.1) and current treatment with transarterial chemoembolization (HR, 4.8; 95% CI, 1.8–12.5). After adjusting for tumor stage and Child-Pugh class, treatment underuse (HR, 0.33; 95% CI, 0.24–0.46) and delayed treatment (HR, 0.50; 95% CI, 0.30–0.84) were both associated with significantly worse survival. Results showed that, in addition to one-third of patients not receiving HCC-directed therapy, another 30% experienced significant therapeutic delays, leading to worse survival.
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影响因子：
25.7
作者：
Cillo, U;Vitale, A;D'Amico, DF
通讯作者：
D'Amico, DF
影响因子：
45.3
作者：
McLaughlin, John M.;Anderson, Roger T.;Paskett, Electra D.
通讯作者：
Paskett, Electra D.
DOI：
10.1158/1055-9965.epi-11-1005
发表时间：
2012-05
期刊：
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
影响因子：
--
作者：
Singal AG;Conjeevaram HS;Volk ML;Fu S;Fontana RJ;Askari F;Su GL;Lok AS;Marrero JA
通讯作者：
Marrero JA
影响因子：
45.3
作者：
Altekruse, Sean F.;McGlynn, Katherine A.;Reichman, Marsha E.
通讯作者：
Reichman, Marsha E.
影响因子：
13.5
作者：
Davila, Jessica A.;Morgan, Robert O.;Richardson, Peter A.;Du, Xianglin L.;McGlynn, Katherine A.;El-Serag, Hashem B.
通讯作者：
El-Serag, Hashem B.