Mark F deBettencourt, Yirong Liu, Scott J Cotler, Chris A Molvar, Tamer Abdelrahman, Tarita O Thomas
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引用次数: 0
Abstract
Objectives: Stereotactic Body Radiotherapy (SBRT) and Yttrium-90 (Y90) are among the ablative therapies used as treatment options for localized hepatocellular carcinoma (HCC). To date, direct comparisons of the 2 modalities' outcomes and costs are lacking. This study aimed to analyze demographic, treatment, and cost information for patients with HCC treated with SBRT and Y90.
Methods: Patients with HCC treated with SBRT or Y90 radioembolization between January 2018 and January 2020 at one institution were retrospectively reviewed. Demographic and treatment data were compared utilizing χ 2 tests. Kaplan-Meier curves and log-rank tests were applied to compare overall survival and progression-free survival in different treatment groups. Cox proportional hazard models were applied to analyze the unadjusted and adjusted survival differences. Ten SBRT and 10 Y90 patients were randomly selected for Medicare cost analysis.
Results: Sixty-three patients received Y90, and 21 received SBRT. On univariable and multivariable analysis, there was no significant difference in overall survival or progression-free survival between the Y90 and SBRT cohorts. SBRT patients had higher American Joint Committee on Cancer staging ( P =0.039), greater tumor size (4.07 vs. 2.96 cm, P =0.013), and greater rates of prior liver-directed therapy (71.4% SBRT vs. 12.7% Y90, P <0.001). The average cost for SBRT was $15,148, and Y90 was $41,360.
Conclusions: SBRT and Y90 are effective therapies in the treatment of HCC, specifically having similar overall survival and progression-free survival. Y90 was found to have a significantly higher cost than SBRT. This study demonstrates the need for prospective studies to assess these modalities in treating HCC.
目的:立体定向体放疗(SBRT)和钇-90 (Y90)是用于局部肝细胞癌(HCC)治疗选择的消融疗法之一。迄今为止，缺乏对这两种方式的结果和成本的直接比较。本研究旨在分析HCC患者接受SBRT和Y90治疗的人口统计学、治疗和成本信息。方法:回顾性分析2018年1月至2020年1月在一家机构接受SBRT或Y90放射栓塞治疗的HCC患者。统计学和治疗资料采用χ2检验进行比较。应用Kaplan-Meier曲线和log-rank检验比较不同治疗组的总生存期和无进展生存期。采用Cox比例风险模型分析未调整和调整后的生存差异。随机选取10例SBRT患者和10例Y90患者进行医保成本分析。结果:63例患者接受Y90治疗，21例患者接受SBRT治疗。在单变量和多变量分析中，Y90组和SBRT组的总生存期和无进展生存期没有显著差异。SBRT患者具有更高的美国癌症联合委员会分期(P=0.039)，更大的肿瘤大小(4.07 vs 2.96 cm, P=0.013)和更高的既往肝脏靶向治疗率(71.4% SBRT vs 12.7% Y90, P)。结论:SBRT和Y90是治疗HCC的有效疗法，特别是具有相似的总生存期和无进展生存期。发现Y90的成本明显高于SBRT。本研究表明需要前瞻性研究来评估这些治疗HCC的方式。
期刊介绍：
American Journal of Clinical Oncology is a multidisciplinary journal for cancer surgeons, radiation oncologists, medical oncologists, GYN oncologists, and pediatric oncologists.
The emphasis of AJCO is on combined modality multidisciplinary loco-regional management of cancer. The journal also gives emphasis to translational research, outcome studies, and cost utility analyses, and includes opinion pieces and review articles.
The editorial board includes a large number of distinguished surgeons, radiation oncologists, medical oncologists, GYN oncologists, pediatric oncologists, and others who are internationally recognized for expertise in their fields.
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