| Locoregional therapies for hepatocellular carcinoma: which patients are most likely to gain a survival advantage? | |
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MedLine Citation:
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PMID: 20594260 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND AIM: Locoregional therapies for hepatocellular carcinoma (HCC) are considered to confer a survival advantage, however, the patient group that should be targeted is not clearly defined. This study aimed to determine the impact on survival of locoregional therapies compared with supportive care, within prognostic categories as stratified by the Cancer of the Liver Italian Program (CLIP) scoring system. METHODS: A prospective database was used to identify those patients who were treated with either locoregional therapy (n = 128) or supportive care (n = 92). Survival analysis was performed for groups matched by CLIP score at presentation. Comparison of important prognostic factors was undertaken and univariate and multivariate analysis was performed to assess determinants of survival. RESULTS: Use of locoregional therapies was only associated with a survival benefit in patients with a CLIP score of 1 or 2. In this group, the median survival in patients who received locoregional therapies was 25.0 months (95% confidence interval 22.7-27.4) compared with 8.9 months (95% confidence interval 7.3-10.5) for supportive care (P = 0.001). For patients with CLIP scores of 3 or greater, no survival benefit of locoregional therapies was observed. Multivariate analysis revealed locoregional intervention, CLIP score, tumor symptoms, alpha-fetoprotein level, bilirubin and alkaline phosphatase level as independent prognostic indicators. CONCLUSION: Locoregional therapies should be targeted specifically to patients with non-advanced hepatocellular carcinoma as assessed by validated scoring systems. Use of these therapies in patients with advanced disease does not appear to be associated with a survival benefit and may expose patients to unnecessary harm. |
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Authors:
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Suzanne E Mahady; Barbara Charlton; Patrick Fitzgerald; David J Koorey; John F Perry; Richard C Waugh; Geoffrey W McCaughan; Simone I Strasser |
Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: Journal of gastroenterology and hepatology Volume: 25 ISSN: 1440-1746 ISO Abbreviation: J. Gastroenterol. Hepatol. Publication Date: 2010 Jul |
Date Detail:
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Created Date: 2010-07-02 Completed Date: 2010-10-18 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8607909 Medline TA: J Gastroenterol Hepatol Country: Australia |
Other Details:
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Languages: eng Pagination: 1299-305 Citation Subset: IM |
Affiliation:
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AW Morrow Gastroenterology and Liver Centre, Sydney, New South Wales, Australia. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Carcinoma, Hepatocellular
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mortality*,
pathology,
therapy* Catheter Ablation* / adverse effects, mortality Chemoembolization, Therapeutic* / adverse effects, mortality Chi-Square Distribution Databases as Topic Ethanol / administration & dosage*, adverse effects Female Health Status Indicators Humans Injections Kaplan-Meiers Estimate Liver Neoplasms / mortality*, pathology, therapy* Male Middle Aged Neoplasm Staging New South Wales Palliative Care* Patient Selection* Proportional Hazards Models Prospective Studies Risk Assessment Risk Factors Time Factors Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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64-17-5/Ethanol |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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