PDF(Pubmed)
Abstract：
BACKGROUND: Patients with Barcelona clinic liver cancer (BCLC) stage B hepatocellular carcinoma (HCC) are considerably heterogeneous in terms of tumor burden, liver function, and performance status. To improve the poor survival outcomes of these patients, treatment approaches other than transarterial chemoembolization (TACE), which is recommended by HCC guidelines, have been adopted in real-world clinical practice. We hypothesize that this non-adherence to treatment guidelines, particularly with respect to the use of liver resection, improves survival in patients with stage B HCC.
OBJECTIVE: To assess guideline adherence in South Korean patients with stage B HCC and study its impact on survival.
METHODS: A retrospective analysis was conducted using data from 2008 to 2016 obtained from the Korea Central Cancer Registry. Patients with stage B HCC were categorized into three treatment groups, guideline-adherent, upward, and downward, based on HCC guidelines recommended by the Asian Pacific Association for the Study of the Liver (APASL), the European Association for the Study of the Liver (EASL), and the American Association for the Study of Liver Diseases (AASLD). The primary outcome was HCC-related deaths; tumor recurrence served as the secondary outcome. Survival among the groups was compared using the Kaplan-Meier method and the log-rank test. Predictors of survival outcomes were identified using multivariable Cox regression analysis.
RESULTS: In South Korea, over the study period from 2008 to 2016, a notable trend was observed in adherence to HCC guidelines. Adherence to the EASL guidelines started relatively high, ranging from 77% to 80% between 2008 and 2012, but it gradually declined to 58.8% to 71.6% from 2013 to 2016. Adherence to the AASLD guidelines began at 71.7% to 75.9% from 2008 to 2010, and then it fluctuated between 49.2% and 73.8% from 2011 to 2016. In contrast, adherence to the APASL guidelines remained consistently high, staying within the range of 90.14% to 94.5% throughout the entire study period. Upward treatment, for example with liver resection, liver transplantation, or radiofrequency ablation, significantly improved the survival of patients with BCLC stage B HCC compared to that of patients treated in adherence to the guidelines (for patients analyzed according to the 2000 EASL guidelines, the 5-year survival rates were 63.4% vs 27.2%, P < 0.001), although results varied depending on the guidelines. Progression-free survival rates were also significantly improved upon the use of upward treatments in certain groups. Patients receiving upward treatments were typically < 70 years old, had platelet counts > 105/μL, and serum albumin levels ≥ 3.5 g/dL.
CONCLUSIONS: Adherence to guidelines significantly influences survival in South Korean stage B HCC patients. Curative treatments outperform TACE, but liver resection should be selected with caution due to disease heterogeneity.
OBJECTIVE: To assess guideline adherence in South Korean patients with stage B HCC and study its impact on survival.
METHODS: A retrospective analysis was conducted using data from 2008 to 2016 obtained from the Korea Central Cancer Registry. Patients with stage B HCC were categorized into three treatment groups, guideline-adherent, upward, and downward, based on HCC guidelines recommended by the Asian Pacific Association for the Study of the Liver (APASL), the European Association for the Study of the Liver (EASL), and the American Association for the Study of Liver Diseases (AASLD). The primary outcome was HCC-related deaths; tumor recurrence served as the secondary outcome. Survival among the groups was compared using the Kaplan-Meier method and the log-rank test. Predictors of survival outcomes were identified using multivariable Cox regression analysis.
RESULTS: In South Korea, over the study period from 2008 to 2016, a notable trend was observed in adherence to HCC guidelines. Adherence to the EASL guidelines started relatively high, ranging from 77% to 80% between 2008 and 2012, but it gradually declined to 58.8% to 71.6% from 2013 to 2016. Adherence to the AASLD guidelines began at 71.7% to 75.9% from 2008 to 2010, and then it fluctuated between 49.2% and 73.8% from 2011 to 2016. In contrast, adherence to the APASL guidelines remained consistently high, staying within the range of 90.14% to 94.5% throughout the entire study period. Upward treatment, for example with liver resection, liver transplantation, or radiofrequency ablation, significantly improved the survival of patients with BCLC stage B HCC compared to that of patients treated in adherence to the guidelines (for patients analyzed according to the 2000 EASL guidelines, the 5-year survival rates were 63.4% vs 27.2%, P < 0.001), although results varied depending on the guidelines. Progression-free survival rates were also significantly improved upon the use of upward treatments in certain groups. Patients receiving upward treatments were typically < 70 years old, had platelet counts > 105/μL, and serum albumin levels ≥ 3.5 g/dL.
CONCLUSIONS: Adherence to guidelines significantly influences survival in South Korean stage B HCC patients. Curative treatments outperform TACE, but liver resection should be selected with caution due to disease heterogeneity.
摘要：
背景：巴塞罗那临床肝癌（BCLC）B期肝细胞癌（HCC）患者在肿瘤负荷方面相当异质，肝功能,和性能状态。为了改善这些患者的不良生存结果，经肝动脉化疗栓塞（TACE）以外的治疗方法，这是HCC指南推荐的，已在现实世界的临床实践中被采用。我们假设这种不遵守治疗指南的情况，特别是在使用肝切除术方面，提高B期HCC患者的生存率。
目的：评估韩国B期HCC患者的指南依从性，并研究其对生存率的影响。
方法：使用从韩国中央癌症登记处获得的2008年至2016年的数据进行回顾性分析。B期HCC患者分为三个治疗组，遵循指导方针，向上,向下，根据亚太肝脏研究协会（APASL）推荐的HCC指南，欧洲肝脏研究协会（EASL），和美国肝病研究协会（AASLD）。主要结果是HCC相关死亡；肿瘤复发是次要结果。使用Kaplan-Meier方法和对数秩检验比较各组之间的存活率。使用多变量Cox回归分析确定生存结果的预测因子。
结果：在韩国，在2008年至2016年的研究期间,在遵循HCC指南方面观察到显著趋势.对EASL指南的遵守程度开始相对较高，从2008年至2012年的77%到80%，但从2013年至2016年逐渐下降到58.8%到71.6%。从2008年到2010年，对AASLD指南的遵守率开始为71.7％至75.9％，然后从2011年到2016年在49.2％至73.8％之间波动。相比之下,对APASL指南的坚持率一直很高，在整个研究期间保持在90.14%至94.5%的范围内。向上治疗，例如肝切除术，肝移植,或射频消融，显着提高BCLCB期HCC患者的生存率与遵守指南治疗的患者相比（对于根据2000EASL指南分析的患者，5年生存率分别为63.4%和27.2%，P<0.001)，尽管结果因指南而异。在某些组中使用向上治疗后，无进展生存率也显着提高。接受向上治疗的患者通常<70岁，血小板计数>105/μL，血清白蛋白水平≥3.5g/dL。
结论：遵循指南显著影响韩国B期HCC患者的生存率。治疗效果优于TACE,但由于疾病异质性，应谨慎选择肝切除术。
目的：评估韩国B期HCC患者的指南依从性，并研究其对生存率的影响。
方法：使用从韩国中央癌症登记处获得的2008年至2016年的数据进行回顾性分析。B期HCC患者分为三个治疗组，遵循指导方针，向上,向下，根据亚太肝脏研究协会（APASL）推荐的HCC指南，欧洲肝脏研究协会（EASL），和美国肝病研究协会（AASLD）。主要结果是HCC相关死亡；肿瘤复发是次要结果。使用Kaplan-Meier方法和对数秩检验比较各组之间的存活率。使用多变量Cox回归分析确定生存结果的预测因子。
结果：在韩国，在2008年至2016年的研究期间,在遵循HCC指南方面观察到显著趋势.对EASL指南的遵守程度开始相对较高，从2008年至2012年的77%到80%，但从2013年至2016年逐渐下降到58.8%到71.6%。从2008年到2010年，对AASLD指南的遵守率开始为71.7％至75.9％，然后从2011年到2016年在49.2％至73.8％之间波动。相比之下,对APASL指南的坚持率一直很高，在整个研究期间保持在90.14%至94.5%的范围内。向上治疗，例如肝切除术，肝移植,或射频消融，显着提高BCLCB期HCC患者的生存率与遵守指南治疗的患者相比（对于根据2000EASL指南分析的患者，5年生存率分别为63.4%和27.2%，P<0.001)，尽管结果因指南而异。在某些组中使用向上治疗后，无进展生存率也显着提高。接受向上治疗的患者通常<70岁，血小板计数>105/μL，血清白蛋白水平≥3.5g/dL。
结论：遵循指南显著影响韩国B期HCC患者的生存率。治疗效果优于TACE,但由于疾病异质性，应谨慎选择肝切除术。
