Skip to main content
Erschienen in: Annals of Surgical Oncology 4/2015

01.04.2015 | Hepatobiliary Tumors

Aggressive Therapeutic Strategies Improve the Survival of Hepatocellular Carcinoma Patients with Performance Status 1 or 2: A Propensity Score Analysis

verfasst von: Chia-Yang Hsu, MD, MPH, Po-Hong Liu, MD, Yun-Hsuan Lee, MD, Cheng-Yuan Hsia, MD, Yi-Hsiang Huang, MD, PhD, Yi-You Chiou, MD, Ya-Ju Tsai, MSN, ACNP-BC, Teddy S. Nagaria, MD, PhD, Teh-Ia Huo, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 4/2015

Einloggen, um Zugang zu erhalten

Abstract

Background

Targeted therapy or chemotherapy is suggested as standard treatment for hepatocellular carcinoma (HCC) patients with performance status (PS) 1–2 according to the Barcelona Clinic Liver Cancer (BCLC) system. The underlying rationales have not been fully studied.

Methods

This study enrolled 2,620 HCC patients. One-to-one matched pairs between HCC patients receiving aggressive anti-HCC treatments (resection, transplantation, ablation, and transarterial chemoembolization) and those receiving targeted therapy or chemotherapy or best supportive care were generated by using the propensity score with a matching model. Survival analysis was performed with the Kaplan–Meier method and the log-rank test. Mortality risk was calculated with the Cox proportional hazards model.

Results

Of 793 patients with PS 1–2, 64 % received aggressive anti-HCC treatments against the suggestion of the BCLC system. The patients receiving aggressive anti-HCC treatments had significantly milder cirrhosis, a smaller tumor burden, and better long-term survival than the patients undergoing targeted therapy or chemotherapy or best supportive care (all p < 0.05). With the use of propensity scores, 166 pairs of matched HCC patients with PS 1–2 were selected from different treatment groups. After matching, patients were comparable in age, gender, severity of cirrhosis, tumor burden, and prevalence of diabetes mellitus (all p > 0.05) at baseline. In the propensity score model, patients with PS 1–2 undergoing aggressive anti-HCC treatments had significantly better long-term survival (p < 0.0001). The adjusted hazard ratio of the choice for targeted therapy or chemotherapy or best supportive care to the choice for aggressive anti-HCC treatments was 2.028 (p < 0.0001).

Conclusions

According to the findings, HCC patients with PS 1–2 should consider aggressive anticancer treatments if no contraindication is noted. Adjustment of the BCLC treatment allocation is needed to enhance its prognostic accuracy.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.CrossRefPubMed Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.CrossRefPubMed
2.
Zurück zum Zitat El-Serag HB, Marrero JA, Rudolph L, Reddy KR. Diagnosis and treatment of hepatocellular carcinoma. Gastroenterology. 2008;134:1752–63.CrossRefPubMed El-Serag HB, Marrero JA, Rudolph L, Reddy KR. Diagnosis and treatment of hepatocellular carcinoma. Gastroenterology. 2008;134:1752–63.CrossRefPubMed
3.
Zurück zum Zitat Dufour JF, Bargellini I, De Maria N, et al. Intermediate hepatocellular carcinoma: current treatments and future perspectives. Ann Oncol. 2013;24(Suppl 2):ii24–9. Dufour JF, Bargellini I, De Maria N, et al. Intermediate hepatocellular carcinoma: current treatments and future perspectives. Ann Oncol. 2013;24(Suppl 2):ii24–9.
5.
Zurück zum Zitat EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56:908–43. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56:908–43.
6.
Zurück zum Zitat Llovet JM, Bru C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis. 1999;19:329–38.CrossRefPubMed Llovet JM, Bru C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis. 1999;19:329–38.CrossRefPubMed
7.
Zurück zum Zitat Hsu CY, Lee YH, Liu PH, et al. Decrypting cryptogenic hepatocellular carcinoma: clinical manifestations, prognostic factors and long-term survival by propensity score model. PLoS One. 2014;9:e89373. Hsu CY, Lee YH, Liu PH, et al. Decrypting cryptogenic hepatocellular carcinoma: clinical manifestations, prognostic factors and long-term survival by propensity score model. PLoS One. 2014;9:e89373.
8.
Zurück zum Zitat Hsu CY, Hsia CY, Huang YH, et al. Comparison of surgical resection and transarterial chemoembolization for hepatocellular carcinoma beyong the Milan criteria: a propensity score analysis. Ann Surg Oncol. 2012;19:842–9.CrossRefPubMed Hsu CY, Hsia CY, Huang YH, et al. Comparison of surgical resection and transarterial chemoembolization for hepatocellular carcinoma beyong the Milan criteria: a propensity score analysis. Ann Surg Oncol. 2012;19:842–9.CrossRefPubMed
9.
Zurück zum Zitat Bruix J, Sherman M, Llovet JM, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol. 2001;35:421–30.CrossRefPubMed Bruix J, Sherman M, Llovet JM, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol. 2001;35:421–30.CrossRefPubMed
10.
Zurück zum Zitat Lee YH, Hsu CY, Hsia CY, et al. Alcoholism worsens the survival of patients with hepatitis B virus and C virus-related hepatocellular carcinoma. Hepatol Int. 2013;7:645–54.CrossRef Lee YH, Hsu CY, Hsia CY, et al. Alcoholism worsens the survival of patients with hepatitis B virus and C virus-related hepatocellular carcinoma. Hepatol Int. 2013;7:645–54.CrossRef
11.
Zurück zum Zitat Hsu CY, Lee YH, Huang YH, et al. Ascites in patients with hepatocellular carcinoma: prevalence, associated factors, prognostic impact, and staging strategy. Hepatol Int. 2013;7:188–98.CrossRef Hsu CY, Lee YH, Huang YH, et al. Ascites in patients with hepatocellular carcinoma: prevalence, associated factors, prognostic impact, and staging strategy. Hepatol Int. 2013;7:188–98.CrossRef
12.
Zurück zum Zitat Hsu CY, Lee YH, Hsia CY, et al. Performance status in patients with hepatocellular carcinoma: determinants, prognostic impact, and ability to improve the Barcelona Clinic Liver Cancer system. Hepatology. 2013;57:112–9.CrossRefPubMed Hsu CY, Lee YH, Hsia CY, et al. Performance status in patients with hepatocellular carcinoma: determinants, prognostic impact, and ability to improve the Barcelona Clinic Liver Cancer system. Hepatology. 2013;57:112–9.CrossRefPubMed
13.
Zurück zum Zitat Hsu CY, Huang YH, Hsia CY, et al. A new prognostic model for hepatocellular carcinoma based on total tumor volume: the Taipei Integrated Scoring system. J Hepatol. 2010;53:108–17.CrossRefPubMed Hsu CY, Huang YH, Hsia CY, et al. A new prognostic model for hepatocellular carcinoma based on total tumor volume: the Taipei Integrated Scoring system. J Hepatol. 2010;53:108–17.CrossRefPubMed
14.
Zurück zum Zitat Austin PC, Schuster T. The performance of different propensity score methods for estimating absolute effects of treatments on survival outcomes: a simulation study. Stat Methods Med Res. 2014 (in press). Austin PC, Schuster T. The performance of different propensity score methods for estimating absolute effects of treatments on survival outcomes: a simulation study. Stat Methods Med Res. 2014 (in press).
16.
Zurück zum Zitat Hsu CY, Lee YH, Hsia CY, et al. Performance status enhances the selection of treatment for patients with hepatocellular carcinoma within the milan criteria. Ann Surg Oncol. 2013;20:2035–42.CrossRefPubMed Hsu CY, Lee YH, Hsia CY, et al. Performance status enhances the selection of treatment for patients with hepatocellular carcinoma within the milan criteria. Ann Surg Oncol. 2013;20:2035–42.CrossRefPubMed
17.
Zurück zum Zitat Lee YH, Hsia CY, Hsu CY, et al. Total tumor volume is a better marker of tumor burden in hepatocellular carcinoma defined by the Milan criteria. World J Surg. 2013;37:1348–55.CrossRefPubMed Lee YH, Hsia CY, Hsu CY, et al. Total tumor volume is a better marker of tumor burden in hepatocellular carcinoma defined by the Milan criteria. World J Surg. 2013;37:1348–55.CrossRefPubMed
18.
Zurück zum Zitat Lee YH, Hsu CY, Huo TI. Assessing liver dysfunction in cirrhosis: role of the model for end-stage liver disease and its derived systems. J Chin Med Assoc. 2013;76:419–24.CrossRefPubMed Lee YH, Hsu CY, Huo TI. Assessing liver dysfunction in cirrhosis: role of the model for end-stage liver disease and its derived systems. J Chin Med Assoc. 2013;76:419–24.CrossRefPubMed
19.
Zurück zum Zitat Gomaa AI, Hashim MS, Waked I. Comparing staging systems for predicting prognosis and survival in patients with hepatocellular carcinoma in egypt. PLoS One. 2014;9:e90929.CrossRefPubMedCentralPubMed Gomaa AI, Hashim MS, Waked I. Comparing staging systems for predicting prognosis and survival in patients with hepatocellular carcinoma in egypt. PLoS One. 2014;9:e90929.CrossRefPubMedCentralPubMed
20.
Zurück zum Zitat Kim BK, Kim SU, Park JY, et al. Applicability of BCLC stage for prognostic stratification in comparison with other staging systems: single-centre experience from long-term clinical outcomes of 1,717 treatment-naive patients with hepatocellular carcinoma. Liver Int. 2012;32:1120–7.CrossRefPubMed Kim BK, Kim SU, Park JY, et al. Applicability of BCLC stage for prognostic stratification in comparison with other staging systems: single-centre experience from long-term clinical outcomes of 1,717 treatment-naive patients with hepatocellular carcinoma. Liver Int. 2012;32:1120–7.CrossRefPubMed
21.
Zurück zum Zitat Kim BH, Park JW, Nam BH, et al. Validation of a model to estimate survival in ambulatory patients with hepatocellular carcinoma: a single-centre cohort study. Liver Int. 2014 (in press). Kim BH, Park JW, Nam BH, et al. Validation of a model to estimate survival in ambulatory patients with hepatocellular carcinoma: a single-centre cohort study. Liver Int. 2014 (in press).
22.
Zurück zum Zitat Weinmann A, Koch S, Niederle IM, et al. Trends in epidemiology, treatment, and survival of hepatocellular carcinoma patients between 1998 and 2009: an analysis of 1,066 cases of a German HCC Registry. J Clin Gastroenterol. 2014;48:279–89.CrossRefPubMed Weinmann A, Koch S, Niederle IM, et al. Trends in epidemiology, treatment, and survival of hepatocellular carcinoma patients between 1998 and 2009: an analysis of 1,066 cases of a German HCC Registry. J Clin Gastroenterol. 2014;48:279–89.CrossRefPubMed
23.
Zurück zum Zitat Ruzzenente A, Capra F, Pachera S, et al. Is liver resection justified in advanced hepatocellular carcinoma? Results of an observational study in 464 patients. J Gastrointest Surg. 2009;13:1313–20.CrossRefPubMed Ruzzenente A, Capra F, Pachera S, et al. Is liver resection justified in advanced hepatocellular carcinoma? Results of an observational study in 464 patients. J Gastrointest Surg. 2009;13:1313–20.CrossRefPubMed
24.
Zurück zum Zitat Kudo M, Osaki Y, Matsunaga T, et al. Hepatocellular carcinoma in Child-Pugh C cirrhosis: prognostic factors and survival benefit of nontransplant treatments. Dig Dis. 2013;31:490–8.CrossRefPubMed Kudo M, Osaki Y, Matsunaga T, et al. Hepatocellular carcinoma in Child-Pugh C cirrhosis: prognostic factors and survival benefit of nontransplant treatments. Dig Dis. 2013;31:490–8.CrossRefPubMed
25.
Zurück zum Zitat Yau T, Tang VY, Yao TJ, et al. Development of Hong Kong Liver cancer staging system with treatment stratification for patients with Hepatocellular Carcinoma. Gastroenterology. 2014 (in press). Yau T, Tang VY, Yao TJ, et al. Development of Hong Kong Liver cancer staging system with treatment stratification for patients with Hepatocellular Carcinoma. Gastroenterology. 2014 (in press).
26.
Zurück zum Zitat Llovet JM, Ricci S, Mazzaferro V, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008;359:378–90.CrossRefPubMed Llovet JM, Ricci S, Mazzaferro V, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008;359:378–90.CrossRefPubMed
27.
Zurück zum Zitat Tokushige K, Hashimoto E, Yatsuji S, et al. Prospective study of hepatocellular carcinoma in nonalcoholic steatohepatitis in comparison with hepatocellular carcinoma caused by chronic hepatitis C. J Gastroenterol. 2010;45:960–7.CrossRefPubMed Tokushige K, Hashimoto E, Yatsuji S, et al. Prospective study of hepatocellular carcinoma in nonalcoholic steatohepatitis in comparison with hepatocellular carcinoma caused by chronic hepatitis C. J Gastroenterol. 2010;45:960–7.CrossRefPubMed
28.
Zurück zum Zitat Cabibbo G, Genco C, Di Marco V, et al. Predicting survival in patients with hepatocellular carcinoma treated by transarterial chemoembolisation. Aliment Pharmacol Ther. 2011;34:196–204.CrossRefPubMed Cabibbo G, Genco C, Di Marco V, et al. Predicting survival in patients with hepatocellular carcinoma treated by transarterial chemoembolisation. Aliment Pharmacol Ther. 2011;34:196–204.CrossRefPubMed
29.
Zurück zum Zitat Liu PH, Lee YH, Hsia CY, et al. Surgical resection versus transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombosis: a propensity score analysis. Ann Surg Oncol. 2014;21:1825–33.CrossRefPubMed Liu PH, Lee YH, Hsia CY, et al. Surgical resection versus transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombosis: a propensity score analysis. Ann Surg Oncol. 2014;21:1825–33.CrossRefPubMed
Metadaten
Titel
Aggressive Therapeutic Strategies Improve the Survival of Hepatocellular Carcinoma Patients with Performance Status 1 or 2: A Propensity Score Analysis
verfasst von
Chia-Yang Hsu, MD, MPH
Po-Hong Liu, MD
Yun-Hsuan Lee, MD
Cheng-Yuan Hsia, MD
Yi-Hsiang Huang, MD, PhD
Yi-You Chiou, MD
Ya-Ju Tsai, MSN, ACNP-BC
Teddy S. Nagaria, MD, PhD
Teh-Ia Huo, MD
Publikationsdatum
01.04.2015
Verlag
Springer US
Erschienen in
Annals of Surgical Oncology / Ausgabe 4/2015
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-4151-2

Weitere Artikel der Ausgabe 4/2015

Annals of Surgical Oncology 4/2015 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.