符合索拉非尼治疗条件的晚期肝细胞癌患者的生存率与报销和医生意识的关系

Hui‐Ling Huang, Te‐Sheng Chang, Lariza Marie Canseco, Fan Wu, Sheng‐Nan Lu
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摘要

2008 年,索拉非尼成为首个获准用于晚期 HCC 的全身治疗药物。虽然索拉非尼的药理疗效已得到证实,但对这种高成本新药的报销以及医生的认识和处方实践同样会影响其临床疗效。因此,我们进行了一项回顾性研究,以索拉非尼获批但尚未报销时的 38 例符合索拉非尼治疗条件的晚期 HCC 患者为对照,并以报销后的 216 例患者为研究对象。研究组的生存期为 8.2 个月,对照组为 4.9 个月(p = 0.0063 危险比:0.612 [0.431 ~ 0.868],p = 0.0059)。在存活超过 2 年的 42 例(19.4%)患者中,50% 的患者出现肿瘤破裂,所有 32 例出现门静脉瘤栓和/或肝外转移的患者都接受了索拉非尼治疗(p = 0.003)。此外,在接受 HCC 治疗的头 2 年中,2 至 5 年的幸存者中有 29.1%的疗程使用了索拉非尼,而 5 年以上的幸存者中有 55.8%的疗程使用了索拉非尼(p = 0.001)。总之,索拉非尼报销后,符合条件的 HCC 患者的生存率明显提高。除肿瘤破裂患者外,索拉非尼治疗时间更长的患者生存率更高。因此,对新引进药物进行报销并提高处方意识可提高临床疗效。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Role of reimbursement and Physicians' awareness in the survival of sorafenib‐eligible advanced hepatocellular carcinoma patients
In 2008, sorafenib became the first approved systemic therapeutic agent for advanced HCC. Although its pharmacological efficacy has been established, reimbursement for such a new, high‐cost drug, as well as physicians' awareness and prescription practice, likewise contribute to its clinical effectiveness. We therefore conducted a retrospective study using 38 sorafenib‐eligible, advanced HCC patients when sorafenib was approved but not yet reimbursed as a control and 216 patients during the reimbursed era. Study group showed longer survival at 8.2 months versus the control's 4.9 months (p = 0.0063 hazard ratio: 0.612 [0.431 ~ 0.868], p = 0.0059). Among the 42 (19.4%) patients who survived more than 2 years, 50% had tumor rupture, and all 32 patients with portal vein tumor thrombus and/or extrahepatic metastasis received sorafenib (p = 0.003). Furthermore, during their first 2 years of HCC management, sorafenib had been given in 29.1% of the treatment courses among survivors between 2 and 5 years while it was prescribed in 55.8% among the more than 5 years survivor group (p < 0.001). In conclusion, survival of sorafenib‐eligible HCC patients significantly improved after reimbursement. Patients who underwent longer sorafenib treatment had a survival advantage, except for those with tumor rupture. Reimbursement and awareness of prescriptions for a newly introduced medication therefore improve clinical effectiveness.
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