| Autor: |
Köstek O; Department of Medical Oncology, Marmara University, Istanbul, Turkiye., Demirel A; Department of Medical Oncology, Marmara University, Istanbul, Turkiye., Hacıoğlu MB; Department of Medical Oncology, Trakya University, Istanbul, Turkiye., Tastekin D; Department of Medical Oncology, Istanbul University, Istanbul, Turkiye., Karabulut S; Department of Medical Oncology, Istanbul University, Istanbul, Turkiye., Gündogdu A; Department of Medical Oncology, Marmara University, Istanbul, Turkiye., Sever N; Department of Medical Oncology, Marmara University, Istanbul, Turkiye., Ayhan M; Clinic of Medical Oncology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkiye., Çelebi A; Department of Medical Oncology, Marmara University, Istanbul, Turkiye., Majidova N; Department of Medical Oncology, Marmara University, Istanbul, Turkiye., Yaşar A; Department of Medical Oncology, Marmara University, Istanbul, Turkiye., Ağyol Y; Department of Medical Oncology, Marmara University, Istanbul, Turkiye., Erel P; Department of Medical Oncology, Marmara University, Istanbul, Turkiye., Kocaaslan E; Department of Medical Oncology, Marmara University, Istanbul, Turkiye., Güren AK; Department of Medical Oncology, Marmara University, Istanbul, Turkiye., Arıkan R; Department of Medical Oncology, Marmara University, Istanbul, Turkiye., Isık S; Department of Medical Oncology, Marmara University, Istanbul, Turkiye., Ercelep O; Department of Medical Oncology, Marmara University, Istanbul, Turkiye., Goksu SS; Department of Medical Oncology, Antalya University, Antalya, Turkiye., Alandag C; Department of Medical Oncology, Cumhuriyet University, Sivas, Turkiye., Bilgetekin İ; Dr Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Turkiye., Caner B; Department of Medical Oncology, Uludag University, Bursa, Turkiye., Sahin AB; Department of Medical Oncology, Uludag University, Bursa, Turkiye., Gulmez A; Faculty of Medicine, Department of Medical Oncology, Inonu University, Malatya, Turkey., Akagunduz B; Clinic of Medical Oncology, Mengucekgazi Training and Research Hospital, Erzincan, Turkiye., Kose F; Department of Medical Oncology, Baskent University, Adana, Turkiye., Kaplan MA; Department of Medical Oncology, Dicle University, Diyarbakir, Turkiye., Dogan E; Department of Medical Oncology, Erciyes University, Kayseri, Turkiye., Sakalar T; Department of Medical Oncology, Erciyes University, Kayseri, Turkiye., Guven DC; Department of Medical Oncology, Hacettepe University, Ankara, Turkiye., Gurbuz M; Department of Medical Oncology, Ankara University, Ankara, Turkiye., Ergun Y; Department of Medical Oncology, Ankara Numune Training and Research Hospital, Ankara, Turkiye., Karaagac M; Department of Medical Oncology, Necmettin Erbakan University, Konya, Turkiye., Turker S; Clinic of Medical Oncology, Ankara Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkiye., Ozkul O; Department of Medical Oncology, Sakarya University, Sakarya, Turkıye., Yıldız B; Department of Medical Oncology, Gülhane Training and Research Hospital, Ankara, Turkey., Sahin S; Department of Medical Oncology, Van Education and Research Hospital, Van, Turkey., Demiray AG; Department of Medical Oncology, Pamukkale University, Denizli, Turkiye., Sari M; Department of Medical Oncology, Marmara University, Istanbul, Turkiye., Erdogan B; Department of Medical Oncology, Trakya University, Istanbul, Turkiye., Hacıbekiroglu İ; Department of Medical Oncology, Sakarya University, Sakarya, Turkıye., Çakmak Öksüzoğlu ÖB; Dr Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Turkiye., Kilickap S; Department of Medical Oncology, Hacettepe University, Ankara, Turkiye., Bilici A; Department of Medical Oncology, Medipol University, Istanbul, Turkiye., Bayoglu İV; Department of Medical Oncology, Marmara University, Istanbul, Turkiye., Topaloglu S; Department of Medical Oncology, Trakya University, Istanbul, Turkiye., Cicin İ; Department of Medical Oncology, Trakya University, Istanbul, Turkiye. |
| Abstrakt: |
The prognosis of patients with advanced HCC can vary widely depending on factors such as the stage of the cancer, the patient's overall health, and treatment regimens. This study aimed to investigate survival outcomes and associated factors in patients with hepatocellular carcinoma (HCC). In this retrospective study, data from 23 medical oncology clinics were analyzed. Progression-free survival (PFS) and overall survival (OS) values were estimated using the Kaplan-Meier method. Prognostic factors associated with survival which were identified in univariate analysis were subsequently evaluated in a multivariate Cox-regression survival analysis was conducted using the backward stepwise (Conditional LR) method to determine the independent predictors of PFS and OS. Of 280 patients, 131 received chemotherapy and 142 received sorafenib, 6 received atezolizumab plus bevacizumab and 1 received nivolumab for first-line setting. The median follow-up time was 30.4 (95%CI 27.1-33.6) months. For-first line, median PFS was 3.1 (95%CI2.7-3.5) months, and it was significantly longer in patients who received sorafenib or atezolizumab-bevacizumab or nivolumab (PFS 5.8 (95%CI 4.2-7.5) than in those received chemotherapy (PFS 2.1 (95%CI 1.9-2.3) in the first-line setting (p < 0.001). Multivariate analysis revealed that male gender (HR: 2.75, 95% CI: 1.53-4.94, p = 0.01), poor ECOG performance score (HR: 1.88, 95% CI: 1.10-3.21, p = 0.02), higher baseline AFP level (HR: 2.38, 95% CI: 1.54-3.67, p < 0.001) and upfront sorafenib treatment (HR,0.38; 95% CI: 0.23-0.62, p < 0.001) were significantly associated with shorter PFS. The median OS was 13.2 (95%CI 11.1-15.2) months. It was significantly longer in patients who received sorafenib or atezolizumab-bevacizumab or nivolumab in the first-line setting followed by TKIs (sorafenib or regorafenib, OS 18.6 (95%CI 13.8-23.5)) compared to those who received chemotherapy (OS 10.3 (95%CI 6.6-14.1)) in the first-line setting. The multivariate analysis revealed that upfront chemotherapy treatment approach, male gender (HR: 1.77, 95% CI: 1.07-2.94, p = 0.02), poor ECOG performance score (HR: 1.96, 95% CI: 1.24-3.09, p = 0.004) and Child-Pugh score, presence of extrahepatic disease (HR: 1.54, 95% CI: 1.09-2.18, p = 0.01), and higher baseline AFP value (HR: 1.50, 95% CI: 1.03-2.19, p = 0.03) were significantly associated with poor prognosis. Additionally, regarding of treatment sequence, upfront sorafenib followed by regorafenib showed a significantly lower risk of mortality (HR: 0.40, 95% CI: 0.25-0.66, p < 0.001). Sorafenib followed by regorafenib treatment was associated with a significantly lower risk of mortality rather than upfront sorafenib followed by BSC group or upfront chemotherapy followed by TKIs. These findings underscore the importance of the optimal treatment sequences to improve survival in patients with advanced HCC. |
