Treatment and prognostic factors in patients with hepatocellular carcinoma

Détails

ID Serval
serval:BIB_265DA89E2A15
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Treatment and prognostic factors in patients with hepatocellular carcinoma
Périodique
Liver International : Official Journal of the International Association For the Study of the Liver
Auteur(s)
Martins A., Cortez-Pinto H., Marques-Vidal P., Mendes N., Silva S., Fatela N., Glória H., Marinho R., Távora I., Ramalho F., de Moura M.C.
ISSN
1478-3223 (Print)
ISSN-L
1478-3223
Statut éditorial
Publié
Date de publication
2006
Volume
26
Numéro
6
Pages
680-687
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
INTRODUCTION: Hepatocellular carcinoma is a leading cause of death from cancer worldwide. Survival of patients depends on tumor extension and liver function, but yet there is no consensual prognostic model.
AIMS: To evaluate the influence on survival of pretreatment parameters (clinico-laboratorial, liver function, tumor extension, Okuda and Cancer of the Liver Italian program (CLIP) staging) and treatment modalities.
METHODS: We retrospectively analyzed 207 patients, diagnosed between 1993 and 2003. The initial treatment was: surgery--six patients; radiofrequency ablation--21; percutaneous ethanol injection--29; transarterial chemoembolization--49; tamoxifen--49; supportive care alone--53. Factors determining survival were assessed by Kaplan-Meier method and Cox regression models.
RESULTS: Median survival was 24 months. In univariate analysis, Child-Pugh classification and Model for end-stage liver disease (MELD) score, portal vein thrombosis (PVT), tumor size, number of lesions, Okuda and CLIP scores were all associated with prognosis (P < 0.001). Alpha-fetoprotein levels were not predictive of survival. Independent predictors of survival were ascites, bilirubin, PVT and therapeutic modalities (P < 0.001). In early stage hepatocellular carcinoma (HCC), survival was similar for both percutaneous ablation modalities, either radiofrequency or ethanol injection (P = NS). In advanced HCC, survival was better in patients receiving tamoxifen than supportive care alone (P < 0.001).
CONCLUSION: This study reinforces the importance of baseline liver function (Child-Pugh classification and MELD score) in the survival of patients with HCC, although staging systems allowed the stratification of patients in different prognostic groups. Ascites, bilirubin and PVT were independent pretreatment predictors of survival. All treatments influenced the patient's outcome, whether in early or advanced stages.
Mots-clé
Carcinoma, Hepatocellular/mortality, Carcinoma, Hepatocellular/physiopathology, Carcinoma, Hepatocellular/therapy, Liver Neoplasms/mortality, Liver Neoplasms/physiopathology, Liver Neoplasms/therapy
Pubmed
Web of science
Création de la notice
01/12/2016 15:01
Dernière modification de la notice
21/07/2020 6:20
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