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J Clin Gastroenterol:积极的治疗能延长原发性肝细胞癌患者的存活

2015-02-28 MedSci 范伟

目标和背景:巴塞罗那临床肝癌(BCLC)系统对肝细胞癌(HCC)体能状态(PS)3-4的患者建议最佳的支持治疗作为标准治疗。探讨治疗分配的理论基础。 研究:共2660例肝癌患者纳入进行回顾性分析。采用倾向评分匹配模型对体能状态 3和4之间的患者进行一对一配对接受支持治疗和抗肝癌治疗。存活分析采用 Kaplan-Meier 法和log-rank检验进行。Cox比例风险模型计算危害比。 结果:32

目标和背景:巴塞罗那临床肝癌(BCLC)系统对肝细胞癌(HCC)体能状态(PS)3-4的患者建议最佳的支持治疗作为标准治疗。探讨治疗分配的理论基础。

研究:共2660例肝癌患者纳入进行回顾性分析。采用倾向评分匹配模型对体能状态 3和4之间的患者进行一对一配对接受支持治疗和抗肝癌治疗。存活分析采用 Kaplan-Meier 法和log-rank检验进行。Cox比例风险模型计算危害比。

结果:328例体能状态 3-4的患者中,38%的患者接受积极的抗肝癌治疗的患者超过了巴塞罗那临床肝癌(BCLC)系统的评分。相比于接受支持治疗的患者,接受抗肝癌治疗的患者往往有轻度的肝硬化,较小的肿瘤负荷,较低的血清α甲胎蛋白水平(P<0.05)。接受支持治疗的患者明显的存活降低(P<0.0001)。101对体能状态3-4类似肝癌的患者从不同的治疗组中选择出来参与倾向得分。他们的年龄,性别,肝脏疾病的病因,肝硬化的严重程度,肿瘤的负担,和糖尿病的患病率(P>0.05)在基线进行比较。在匹配模型上,体能状态3-4接受支持治疗的患者在调整的危害比4.711时(置信区间:3.041-7.297,P<0.0001)明显的缩短了存活期。

结论:在这项研究中,超过1/3接受积极的抗肝癌治疗的体能状态3-4的患者超过了巴塞罗那临床肝癌(BCLC)系统分配算法的得分。若没有明显的禁忌症,应该采取活跃的抗癌疗法而不是最佳的支持治疗。

原始出处

Hsu CY, Liu PH, Lee YH, Hsia CY, Huang YH, Tsai YJ, Nagaria TS, Lin HC, Huo TI. Active Treatments Prolong the Survival in Patients With Hepatocellular Carcinoma and Performance Status 3 or 4: A Propensity Score Analysis. J Clin Gastroenterol. 2015 Feb 21.

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    2015-06-17 xjy02
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    2015-05-15 许安
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    2015-05-16 ljjj1053

    很不错学习了

    0

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    2015-02-28 medcardio

    3-4级就是治疗,也是苦活

    0

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