肝细胞癌预后的回顾性单中心队列研究与多中心队列研究的有限普适性比较
IF 4.2
3区 医学
Q2 ONCOLOGY
引用次数: 0
摘要
简介我们旨在通过比较全国多中心队列和单中心队列的HCC患者接受各种治疗后的总生存率（OS），评估回顾性单中心队列研究对肝细胞癌（HCC）预后的可推广性：利用韩国原发性肝癌登记处（多中心队列，人数=16443）和牙山医疗中心HCC登记处（单中心队列，人数=15655）的数据，对2008年1月至2018年12月期间新诊断出的HCC患者进行分析。使用对数秩检验和Cox比例危险模型比较了两个队列的主要结果--初始治疗后的OS，包括整个人群和Child-Pugh A肝功能亚群（分别为2797人和5151人）按照巴塞罗那肝癌临床（BCLC）策略进行治疗的患者：单中心队列中，BCLC 0期和A期患者（59.3% vs 35.2%）以及接受根治性治疗的患者（42.1% vs 32.1%）更常见（Ps< 0.001）。多变量分析显示，根据治疗类型，两个队列的 OS 存在显著差异：多中心队列中接受根治性治疗的患者的死亡风险更高（调整后危险比 [95% 置信区间]，1.48[1.39-1.59]）和非根治性治疗（1.22[1.17-1.27]）的患者死亡风险较高，而接受全身治疗（0.83[0.74-0.92]）和最佳支持治疗（0.85[0.79-0.91]）的患者死亡风险较低。子队列分析还显示，两个队列的OS有显著差异，接受化疗栓塞（1.72 [1.48- 2.00]）和消融（1.44 [1.08- 1.92]）的多中心队列患者的死亡风险更高：单中心和多中心HCC患者队列的比较显示，在调整预后变量后，不同治疗方式的OS存在显著差异。因此，HCC治疗的回顾性单中心队列研究结果可能无法推广到现实世界的实践中：BCLC、UICC、肝癌、回顾性队列、外部验证本文章由计算机程序翻译，如有差异，请以英文原文为准。
Limited Generalizability of Retrospective Single-Center Cohort Study in Comparison to Multicenter Cohort Study on Prognosis of Hepatocellular Carcinoma
Introduction: We aimed to evaluate the generalizability of retrospective single-center cohort studies on prognosis of hepatocellular carcinoma (HCC) by comparing overall survival (OS) after various treatments between a nationwide multicenter cohort and a single-center cohort of HCC patients.
Methods: Patients newly diagnosed with HCC between January 2008 and December 2018 were analyzed using data from the Korean Primary Liver Cancer Registry (multicenter cohort, n=16,443), and the Asan Medical Center HCC registry (single-center cohort, n=15,655). The primary outcome, OS after initial treatment, was compared between the two cohorts for both the entire population and for subcohorts with Child-Pugh A liver function (n=2797 and n=5151, respectively) treated according to the Barcelona-Clinic-Liver-Cancer (BCLC) strategy, using Log rank test and Cox proportional hazard models.
Results: Patients of BCLC stages 0 and A (59.3% vs 35.2%) and patients who received curative treatment (42.1% vs 32.1%) were more frequently observed in the single-center cohort (Ps< 0.001). Multivariable analysis revealed significant differences between the two cohorts in OS according to type of treatment: the multicenter cohort was associated with higher risk of mortality among patients who received curative (adjusted hazard ratio [95% confidence interval], 1.48 [1.39– 1.59]) and non-curative (1.22 [1.17– 1.27]) treatments, whereas the risk was lower in patients treated with systemic therapy (0.83 [0.74– 0.92]) and best supportive care (0.85 [0.79– 0.91]). Subcohort analysis also demonstrated significantly different OS between the two cohorts, with a higher risk of mortality in multicenter cohort patients who received chemoembolization (1.72 [1.48– 2.00]) and ablation (1.44 [1.08– 1.92]).
Conclusion: Comparisons of single-center and multicenter cohorts of HCC patients revealed significant differences in OS according to treatment modality after adjustment for prognostic variables. Therefore, the results of retrospective single-center cohort studies of HCC treatments may not be generalizable to real-world practice.
Keywords: BCLC, UICC, liver cancer, retrospective cohort, external validation
Methods: Patients newly diagnosed with HCC between January 2008 and December 2018 were analyzed using data from the Korean Primary Liver Cancer Registry (multicenter cohort, n=16,443), and the Asan Medical Center HCC registry (single-center cohort, n=15,655). The primary outcome, OS after initial treatment, was compared between the two cohorts for both the entire population and for subcohorts with Child-Pugh A liver function (n=2797 and n=5151, respectively) treated according to the Barcelona-Clinic-Liver-Cancer (BCLC) strategy, using Log rank test and Cox proportional hazard models.
Results: Patients of BCLC stages 0 and A (59.3% vs 35.2%) and patients who received curative treatment (42.1% vs 32.1%) were more frequently observed in the single-center cohort (Ps< 0.001). Multivariable analysis revealed significant differences between the two cohorts in OS according to type of treatment: the multicenter cohort was associated with higher risk of mortality among patients who received curative (adjusted hazard ratio [95% confidence interval], 1.48 [1.39– 1.59]) and non-curative (1.22 [1.17– 1.27]) treatments, whereas the risk was lower in patients treated with systemic therapy (0.83 [0.74– 0.92]) and best supportive care (0.85 [0.79– 0.91]). Subcohort analysis also demonstrated significantly different OS between the two cohorts, with a higher risk of mortality in multicenter cohort patients who received chemoembolization (1.72 [1.48– 2.00]) and ablation (1.44 [1.08– 1.92]).
Conclusion: Comparisons of single-center and multicenter cohorts of HCC patients revealed significant differences in OS according to treatment modality after adjustment for prognostic variables. Therefore, the results of retrospective single-center cohort studies of HCC treatments may not be generalizable to real-world practice.
Keywords: BCLC, UICC, liver cancer, retrospective cohort, external validation
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