The impact of the multiple types of treatments on OS and the decline of liver function in patients with advanced stage of HCC
| Autor: | Aiwu Ruth He, Brandon G. Smaglo, Salha Taher, Michael J. Pishvaian, Lynt B. Johnson, Thomas M. Fishbein, Petra Prins, Marion L. Hartley, Tiger Zhang, Junhao Zhu, Prarthna V Bhardwaj, John Marshall, Hongkun Wang, Coleman Smith, A. Kim, Reena Jha, Mohamed E. Salem, David Sullivan, Rohits Satoskar |
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| Rok vydání: | 2016 |
| Předmět: |
0301 basic medicine
Sorafenib Cancer Research medicine.medical_specialty Radiofrequency ablation macromolecular substances Gastroenterology law.invention 03 medical and health sciences 0302 clinical medicine law Internal medicine otorhinolaryngologic diseases Medicine In patient business.industry Cancer medicine.disease Surgery Log-rank test 030104 developmental biology Oncology 030220 oncology & carcinogenesis Hepatocellular carcinoma Liver function business Liver cancer medicine.drug |
| Zdroj: | Journal of Clinical Oncology. 34:461-461 |
| ISSN: | 1527-7755 0732-183X |
| Popis: | 461 Background: Hepatocellular carcinoma (HCC) is the sixth most common cancer and the second leading cause of cancer-related death worldwide. Most HCCs develop in severely damaged liver. Methods: The effect of multiple treatment options on liver function (LF) and disease outcome of patients (pts) with HCC (n = 185) were examined retrospectively. Pt tumor burden (using Barcelona clinic liver cancer [BCLC] classification) and LF (Child Pugh [CP]) were assessed at time of diagnosis and then after treatment. Using Kaplan Meier with log rank and T tests, BCLC and CP scores were correlated with overall survival (OS) following individual treatment regimens. Results: We show that better BCLC and LF scores at time of diagnosis predict a better outcome (median OS; p < 0.05). Pts received one or more of the following: no treatment, experimental treatment, TACE, Y90 radioembolization, radiofrequency ablation, resection, radiation, and sorafenib (SFB). Considering all treatment scenarios, LF improved in 9.5%, did not change in 33%, and worsened in 57% of pts. Sixty percent of untreated pts experienced LF decline, compared with 33, 54, 48 and 50% of pts receiving TACE, SFB, TACE/SFB, and Y90/SFB, respectively (no significant differences [NS]); 72% of pts receiving TACE/Y90/SFB (NS); and 85% of pts receiving other Y90/SFB combinations (p = 0.006). In general, pts who saw no change or an improvement in LF from baseline had longer median OS versus pts who had declining LF (p < 0.002). However, pts receiving TACE/Y90/SFB (n = 29) had similar OS to those receiving TACE/SFB (n = 35), despite the toxicity difference (72% [TACE/Y90/SFB] vs. 48% [TACE/SFB] of pts had declining LF). TACE/SFB or TACE/Y90/SFB led to longer median OS than any other treatment group (p = 0.017). Conclusions: The outcome of pts with HCC depends on disease stage and LF. Most pts experience LF decline during treatment. Despite LF decline in 48% of pts receiving a SFB/TACE, these pts experienced longer median OS than pts on any other treatment. Balancing survival benefit with liver toxicities is critical to the successful treatment of pts with advanced HCC. Agents with good antitumor activity and minimal liver toxicity are desperately needed for these pts. |
| Databáze: | OpenAIRE |
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