真实世界中经动脉化疗栓塞治疗肝细胞癌患者临床应用调研分析

A survey of the real-world clinical application of TACE in the treatment of hepatocellular carcinoma in China

目的肝细胞癌(HCC)是原发性肝癌最常见的病理学类型,约占90%。中国是全球肝癌发病率和病死亡人数最高的国家。与欧美国家相比,中国的HCC患者在病因、流行病学特征、临床表现与分期、治疗策略选择和预后等方面存在显著差异,即高度异质性。在HCC的治疗中,经动脉化疗栓塞(TACE)作为一项重要的介入技术起着至关重要的作用。本研究对中国接受TACE治疗的HCC患者的临床病理特征、TACE治疗情况和临床结局等进行了系统调研和分析。方法以2012年至2019年中国原发性肝癌临床登记调查数据库中至少接受过1次TACE治疗的HCC患者为调研对象,对患者的临床病理特征、TACE治疗情况等进行描述分析,并且观察比较患者的治疗效果和生存期。结果本研究共纳入5342例至少接受过1次TACE治疗的HCC患者。中位年龄为56.9岁(范围:18.6~92.1岁),以男性为主(占84.0%);乙型肝炎病毒(HBV)感染占75.7%,丙型肝炎病毒(HCV)感染占3.2%;94.3%患者在治疗前ECOG评分为0~1分。在可进行临床分期的患者中,巴塞罗那临床肝癌(BCLC)分期中0~A期占31.9%,B~C期占65.0%,D期占3.1%;而在全部患者中,选择TACE治疗作为首次治疗的患者达到89.7%。中位随访10.7个月,全部患者1、3、5年生存率分别为60.2%、35.1%和25.6%。BCLC分期对接受TACE治疗患者的生存结局具有明显影响(P<0.05)。结论TACE治疗HCC时,可进一步考虑患者的临床病理特征和临床分期,以获得更好的治疗效果。

Objective Hepatocellular carcinoma(HCC),the most common type of primary liver cancer,makes up approximately 90%of liver cancer patients.China is a country with the highest incidence and death number of HCC in the world.Compared with European and American countries,patients with HCC in China are different in their etiology,epidemiological characteristics,clinical manifestation and stage,treatment strategy and prognosis.Transarterial chemoembolization(TACE),as an important interventional technique,plays a crucial role in the treatment of HCC.The objective of this study is to investigate and analyze the clinical characteristics,treatment pattern and outcomes of HCC patients treated with TACE in China.Methods Patients with HCC in the Chinese Primary Liver Cancer Clinical Registry Survey database who underwent at least one TACE from 2012 to 2019 were collected.We described the clinical characteristics and clinical treatment,and observed the survival status of the patients with TACE.Results A total of 5342 patients who underwent at least one TACE were analyzed.Median age at diagnosis was 56.9(range:18.6-92.1)years,and most(84.0%)were male.75.7%and 3.2%of HCC cases were attributable to hepatitis B virus(HBV)and hepatitis C virus(HCV)infections,respectively.Eastern Cooperative Oncology Group performance status(ECOG PS)0-1 accounted for 94.3%of the patients.Among the patients with clinical staging,31.9%were in Barcelona Clinic Liver Cancer(BCLC)stage 0-A,65.0%were in BCLC stage B-C,and 3.1%were in BCLC stage D.89.7%patients in all groups initially received TACE.The median follow-up period was 10.7 months.The 1-,3-and 5-year overall survival rates were 60.2%,35.1%and 25.6%,respectively.The BCLC stage was significantly associated with the survival of the patients treated with TACE(P<0.05).Conclusion Patients′characteristics and clinical stage might be further considered in the treatment of HCC with TACE for better treatment outcomes.