Impact of Sequencing of Treatment Modalities on Survival in Nonmetastatic Hepatocellular Carcinoma.

IF 1.6 4区 医学 Q4 ONCOLOGY
Bakr Alhayek, Firas Baidoun, Danny Hadidi, Muhamad A Moustafa, Omar Abdel-Rahman
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引用次数: 0

Abstract

Objectives: Hepatocellular carcinoma (HCC) is the most common type of liver malignancy and the third leading cause of cancer-related death in the world. Liver transplant is a cornerstone in treating nonmetastatic disease, but a significant portion of patients miss the opportunity of upfront liver transplant given the long waiting time for donor organs. Herein, we compare the survival outcomes between upfront liver transplant, liver transplant with bridge systemic therapy, and systemic therapy only.

Methods: The National Cancer Database was queried for patients diagnosed with non-metastatic hepatocellular carcinoma (HCC) between 2004 and 2017. After including only patients with clinical N0 stage who received either systemic therapy alone, liver transplant alone or liver transplant with bridge systemic therapy, we split the cohort into 3 groups: systemic therapy only (including intra-arterial chemotherapy eg, TACE) group, upfront liver transplant group and liver transplant with bridge systemic therapy group. We evaluated overall survival (OS) among the three groups. We studied the OS using Kaplan-Meier estimates and multivariate Cox regression analyses to evaluate factors associated with overall survival (OS).

Results: A total of 29,691 patients with nonmetastatic HCC were included for analysis, of which 25,122 (84.6%) were treated with systemic therapy only, 2513 (8.5%) were treated with bridge systemic therapy followed by liver transplant, and 2056 (6.9%) were treated with upfront liver transplant without systemic therapy bridge. We found that patients who were treated with bridge systemic therapy followed by liver transplant and patients who were treated with upfront liver transplant had a statistically significantly better OS compared to patients who were treated with systemic therapy only (mean OS was 101.9 mo and 98.2 vs. 39.4 mo, respectively, with P<0.001 for all). Whereas there was no significant difference in OS between patients who were treated with bridge systemic therapy followed by liver transplant and patients who were treated with upfront liver transplant (mean OS was 101.9 vs. 98.2 months, P=0.187). On multivariate analysis, factors associated with worse OS were older age (HR: 1.011; 95% CI: 1.010-1.013; P<0.001), Male sex (HR: 1.048; 95% CI: 1.014-1.084; P=0.006), White compared with African American race (HR: 1.055; 95% CI: 1.012-1.099; P=0.011), no insurance status (HR: 1.155; 95% CI: 1.079-1.237; P<0.001), clinical T4 stage compared with T0 stage (HR: 1.366; 95% CI: 1.257-1.483, P<0.001), and systemic therapy alone compared with upfront liver transplant and liver transplant with bridge systemic therapy (HR for upfront liver transplant and transplant with bridge systemic therapy vs. systemic therapy was 0.202; 95% CI: 0.184-0.223, and HR: 0.194, 95% CI: 0.178-0.212, respectively, with P<0.001 for all).

Conclusions: Patients with nonmetastatic HCC who were treated with upfront liver transplant or liver transplant with bridge systemic therapy had statistically significant improvement in OS compared with patients who were treated with systemic therapy only. While our study confirms the survival benefit of liver transplant among patients with nonmetastatic HCC, these results raise the importance of proceeding with liver transplant after intra-arterial and/or systemic treatments in patients who are not initially eligible for or missed the opportunity of upfront liver transplant.

治疗方式排序对非转移性肝细胞癌患者生存的影响。
目的:肝细胞癌(HCC)是最常见的肝脏恶性肿瘤类型,也是世界上癌症相关死亡的第三大原因。肝移植是治疗非转移性疾病的基石,但由于等待供体器官的时间过长,很大一部分患者错过了前期肝移植的机会。在此,我们比较了术前肝移植、肝移植联合过桥全身治疗和仅全身治疗的生存结果。方法:查询2004年至2017年期间诊断为非转移性肝细胞癌(HCC)的患者的国家癌症数据库。在仅纳入单纯接受全身治疗、单纯肝移植或肝移植联合过桥全身治疗的临床no期患者后,我们将队列分为3组:单纯接受全身治疗(包括动脉内化疗如TACE)组、前期肝移植组和肝移植联合过桥全身治疗组。我们评估了三组患者的总生存期(OS)。我们使用Kaplan-Meier估计和多变量Cox回归分析来评估与总生存期(OS)相关的因素。结果:共纳入29691例非转移性HCC患者,其中25122例(84.6%)仅接受全身治疗,2513例(8.5%)接受过桥全身治疗后肝移植,2056例(6.9%)接受前期肝移植,未接受过桥全身治疗。我们发现,与仅接受全身治疗的患者相比,接受桥式全身治疗后再进行肝移植的患者和接受前期肝移植的患者的OS有统计学意义上的显著改善(平均OS分别为101.9个月和98.2个月vs 39.4个月)。与仅接受全身治疗的患者相比,接受前期肝移植或肝移植联合过桥全身治疗的非转移性HCC患者的OS改善具有统计学意义。虽然我们的研究证实了肝移植对非转移性HCC患者的生存益处,但这些结果提高了在动脉内和/或全身治疗后进行肝移植的重要性,这些患者最初不符合条件或错过了前期肝移植的机会。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.90
自引率
0.00%
发文量
130
审稿时长
4-8 weeks
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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