秘鲁三级转诊医院肝细胞癌患者的无移植生存率

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology Pub Date : 2025-09-01 DOI:10.1016/j.aohep.2025.102038

Mariella Rosalina Huaman Rivera , Diego Francisco Pinto Ruiz , Estefania Liza Baca , Zuly Placido Damian , Javier Diaz Ferrer

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引用次数: 0

摘要

秘鲁是南美洲肝癌发病率最高的国家之一，但由于移植手术的机会有限，因此通过替代治疗来评估预后至关重要。我们的目的是确定在秘鲁利马“国家埃德加多·雷巴利亚蒂·马丁斯医院”（HNERM）治疗的肝细胞癌（HCC）患者的无移植生存率。材料与方法回顾性队列研究，数据来自2012-2014年在我院肝病科住院的患者。我们纳入了通过CT、MRI或活检诊断为HCC的成年人；既往肝移植或随访失败者排除在外。我们回顾了超过120个月的临床记录和全国死亡登记。采用Kaplan-Meier法估计无移植生存期，采用Mantel-Haenszel法评估肝硬化、bclc分期和治疗的生存差异（α=0.05）。结果共纳入112例HCC患者，中位年龄68岁[IQR:60-75岁]，女性占51.8%。HCC的主要病因是病毒性肝炎（HBV 31.3%, HCV 15.2%，合并感染4.5%），其次是NAFLD。87.5%的人有肝硬化，Child-Pugh B.无肝硬化的参与者明显更年轻（p<0.01）。总体而言，57.1%的患者接受了姑息治疗，其次是TACE（28.6%）、化疗（6.3%）、手术（5.4%）和乙醇注射（2.7%）。6个月时无移植存活率为59.8%，120个月时为1.8%。有肝硬化的中位生存期为8.0个月，无肝硬化的中位生存期为11.3个月，无显著差异。手术治疗显示更好的生存结果（p<0.01）（图1）。肝硬化患者的60个月生存率随BCLC分期的不同而有显著差异，更倾向于早期阶段（p<0.01）。结论早期诊断而不考虑肝硬化状况和更广泛的治疗对提高秘鲁HCC患者的生存率至关重要。

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TRANSPLANT-FREE SURVIVAL AMONG PATIENTS WITH HEPATOCELLULAR CARCINOMA MANAGED AT A TERTIARY REFERRAL HOSPITAL IN PERU

Introduction and Objectives

Peru has one of the highest liver cancer rates in South America, yet limited access to transplantation makes evaluating prognosis through alternative treatments essential. We aimed to determine transplant-free survival in patients with hepatocellular carcinoma (HCC) treated at “Hospital Nacional Edgardo Rebagliati Martins” (HNERM), Lima, Peru.

Materials and Methods

Retrospective cohort study using data from patients hospitalized in the hepatology unit of HNERM (2012-2014). We included adults diagnosed with HCC by CT, MRI, or biopsy; those with prior liver transplants or lost to follow-up were excluded. We reviewed clinical records and the national death registry over 120 months. Transplant-free survival was estimated using Kaplan–Meier, and survival differences by cirrhosis, BCLC-stage, and treatment were assessed using the Mantel–Haenszel method (α=0.05).

Results

A total of 112 patients with HCC were included (median age 68 [IQR:60-75years]; 51.8% female). The leading etiology of HCC was viral (HBV 31.3%, HCV 15.2%, co-infection 4.5%), followed by NAFLD. 87.5% had cirrhosis, Child-Pugh B. Participants without cirrhosis were significantly younger (p<0.01). Overall, 57.1% received palliative care, followed by TACE (28.6%), chemotherapy (6.3%), surgery (5.4%), and ethanol injection (2.7%). Transplant-free survival rates were 59.8% at 6 months and 1.8% at 120 months. Median survival was 8.0 months with cirrhosis and 11.3 without, with no significant difference. Surgical treatment showed better survival outcomes (p<0.01) (figure1). Among patients with cirrhosis, 60-month survival significantly varied by BCLC stage, favoring earlier stages (p<0.01)

Conclusions

Early diagnosis regardless of cirrhosis status and broader treatment availability are crucial to improve HCC survival in Peru.

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来源期刊

Annals of hepatology 医学-胃肠肝病学

CiteScore

7.90

自引率

2.60%

发文量

183

审稿时长

4-8 weeks

期刊介绍： Annals of Hepatology publishes original research on the biology and diseases of the liver in both humans and experimental models. Contributions may be submitted as regular articles. The journal also publishes concise reviews of both basic and clinical topics.