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首页> 外文期刊>Hepatology: Official Journal of the American Association for the Study of Liver Diseases >Predictors of survival in patients with advanced hepatocellular carcinoma who permanently discontinued sorafenib
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Predictors of survival in patients with advanced hepatocellular carcinoma who permanently discontinued sorafenib

机译：永久停用索拉非尼的晚期肝细胞癌患者的生存预测指标

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Treatment with sorafenib of patients with advanced hepatocellular carcinoma is challenged by anticipated discontinuation due to tumor progression, liver decompensation, or adverse effects. While postprogression survival is clearly determined by the pattern of tumor progression, understanding the factors that drive prognosis in patients who discontinued sorafenib for any reason may help to improve patient management and second-line trial design. Patients consecutively admitted to three referral centers who were receiving best supportive care following permanent discontinuation of sorafenib for any reason were included. Postsorafenib survival (PSS) was calculated from the last day of treatment to death or last visit available. Two hundred and sixty patients were included in this prospective study, aged 67 years, 60% with hepatitis C, 51% Child-Pugh A, 83% performance status (PS) 1, 41% with macroscopic vascular invasion, and 38% with extrahepatic tumor spread. Overall, median PSS was 4.1 (3.3-4.9) months, resulting from 4.6 (3.3-5.7) months for 123 progressors, 7.3 (6.0-10.0) months in 77 with adverse effects, and 1.8 (1.6-2.4) months in 60 decompensated patients (P<0.001). Postsorafenib survival was independently predicted by PS, prothrombin time, extrahepatic tumor spread, macrovascular invasion, and reason for discontinuation. Two hundred patients potentially eligible for second-line therapy had a PSS of 5.3 (4.6-7.1) months, which was dependent on reasons of discontinuation (P=0.004), PS (P<0.001), macrovascular invasion (P<0.001), and extrahepatic metastases (P<0.002). Conclusion: Discontinuation due to adverse effects in the absence of macrovascular invasion, extrahepatic metastases, and deteriorated PS predicts the best PSS in compensated patients, thereby setting the stage for both improved patient counseling and selection for second-line therapy. (Hepatology 2015;62:784-791)
机译：索拉非尼对晚期肝细胞癌患者的治疗面临因肿瘤进展，肝脏代偿失调或副作用而导致的预期中止治疗的挑战。虽然进展后的存活率显然取决于肿瘤的进展模式，但了解因任何原因停药的索拉非尼患者的预后因素可能有助于改善患者管理和二线试验设计。包括因任何原因永久停用索拉非尼后连续进入三个转诊中心接受最佳支持治疗的患者。从治疗的最后一天到死亡或最后一次就诊，计算索拉非尼后生存期（PSS）。这项前瞻性研究共纳入260例患者，年龄67岁，丙型肝炎60％，Child-Pugh A 51％，运动状态（PS）83％，宏观血管浸润41％，肝外38％肿瘤扩散。总体而言，PSS的中位数为4.1（3.3-4.9）个月，这是由于123名进展者为4.6（3.3-5.7）个月，有不良反应的有77位患者为7.3（6.0-10.0）个月，有失代偿的60位中有1.8（1.6-2.4）个月患者（P <0.001）。 PS，凝血酶原时间，肝外肿瘤扩散，大血管浸润和停药原因可独立预测索拉非尼的生存。可能有资格接受二线治疗的200名患者的PSS为5.3（4.6-7.1）个月，这取决于停药原因（P = 0.004），PS（P <0.001），大血管浸润（P <0.001），和肝外转移（P <0.002）。结论：在没有大血管浸润，肝外转移和PS恶化的情况下，由于不良反应而中断治疗可预测有偿患者的最佳PSS，从而为改善患者咨询和选择二线治疗奠定基础。 （肝病2015; 62：784-791）

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