移植与切除对肝癌病患预后最好

　　January 23, 2007（奥兰多讯）－一项回顾分析超过40,000名肝癌病患的研究结果发现，切除后移植病患预后最好。
　　
　　新伯伦瑞克纽泽西癌症机构Roderich Schwarz医师表示，这些数据显示，移植与切除应该仍是肝癌病患的优先选择；然而，他强调，该回顾性研究并未找出最佳疗法选择为何，这篇文章还未达到建议何种治疗是最佳的、或是应该避免的阶段。
　　
　　他表示，除此之外，许多肝癌病患无法接受移植或手术，因此，继续寻找更不具侵袭性的治疗选择，以获得治疗这些病患的最佳选择是重要的。
　　
　　Schwarz于美国临床肿瘤学会2007肠胃道癌症座谈会（GCS）中报告这项发现，该会议也由ASCO及许多医学会共同举办。
　　
　　Schwarz博士与其同事纪录1997年至2003年之间，共46,065位病患的病历，并且包含于国家癌症机构的流行病学与最终结果（SEER）资料库中；一项多变项分析检验许多预后因子，包括肿瘤大小、肿瘤恶性程度、疾病蔓延情形、病患年龄与性别。
　　
　　相较于接受手术病患的38%与接受烧灼术病患的19%，在校正过已知风险因子后，接受移植病患的存活率最高，移植病患其5年整体存活率为67%，未接受治疗的病患预后最差，5年存活率仅有3%。
　　
　　然而，Schwarz也强调，该试验并未校正许多重要子，SEER资料库并未提供病患整体健康情形，或是其肝脏是否受肝硬化或是肝炎影响，以及肝脏功能，这些因素是很重要的。
　　
　　这些因素强烈地影响提供的治疗种类以及存活率，他表示，这些预后较佳、选择移植与手术的病患，相较于接受其他治疗的病患，较可能有较佳的健康状况、轻微的癌症与功能较佳的肝脏；他附带表示，尤其是对接受移植的病患，这些病患经过严格的条件筛选，最主要的关键在于肿瘤的大小。
　　
　　引言人乔治亚州亚特兰大Emory大学Charles Staley医师于发表会中简短表示，因为肝癌的再发率很高，移植已经成为肝癌偏好的治疗方式；即使你切除第一个肿瘤，第二个肿瘤会在大约6~7个月内出现，他表示，这些病患的肝脏显然是有缺陷的，最好的选择是完全切除它。
　　
　　然而，Staley医师强调，使用烧灼术治疗肝癌，这项技术目前已经提供前所未有的治疗选择，虽然这项回顾性研究暗示烧灼没有较其他治疗选择佳，但他指出，接受烧灼治疗的病患通常疾病较为严重，且病患状况较差，所以直接拿烧灼术与其他治疗选择比较是不公平的，因为它是用来治疗不同族群的病患。
　　
　　Schwarz博士同意这样的讲法，他指出，接受烧灼术治疗的病患通常是因为过度虚弱而无法接受移植或是手术，所以我不认为这是令人失望的，反而是一个好的结果，因为这些病患可以接受烧灼术而不是完全没有治疗选择；目前，烧灼术是缓和疗法而不是治愈疗法，但当这项技术被发展出来，我们可以期待更好的存活率数据；他也表示，这几年这项技术已经越来越普遍，在他们的研究中，于2003年作为切割点，SEER资料库中大约有3%病患接受这项技术治疗。

Transplant and Resection Have Best Survival in Liver Cancer

By Zosia Chustecka
Medscape Medical News

January 23, 2007 (Orlando) ??A review of records for more than 40,000 patients with liver cancer shows that the best overall survival rates are associated with transplantation, followed next by resection.

"These data suggest that transplantation and resection should still be preferentially considered for all hepatocellular carcinoma patients," said the lead author, Roderich Schwarz, MD, from the Cancer Institute of New Jersey, in New Brunswick. He emphasized, however, that "the perfect treatment choice cannot be deducted from this review?.?.?.?it's not sensible to come up with a final recommendation on which treatment is best and which should be avoided."

Also, many patients with liver cancer cannot undergo either transplantation or surgery, and "so it is important to continue to explore less-invasive options to find the optimal treatment for these patients," he commented.

Dr. Schwarz was speaking at a press briefing organized by the American Society of Clinical Oncology here at the 2007 Gastrointestinal Cancers Symposium (GCS), at which he presented the findings. The meeting was cosponsored by ASCO and several other medical societies.

Dr. Schwarz and colleagues analyzed the records of 46,065 patients treated between 1997 and 2003 and included in the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) database. A multivariate analysis examined many prognostic factors, including tumor size and grade, the extent of disease spread, and patient age and sex.

After adjustment for the known factors, patient survival rates were best in the group that received transplants. The 5-year overall survival rates were 67% for transplantation, followed by 38% for surgery and 19% for ablation. Patients who received no treatment did poorly, with 5-year survival rates of only 3%.

However, Dr Schwarz emphasized the fact that many important factors were not adjusted for. The SEER database gave no information on the patients' overall health or whether the liver was affected by cirrhosis or hepatitis or how well it was functioning. These factors are important, he commented, as they strongly influence both the type of treatment that is offered and also the survival rates. He noted that patients chosen for transplantation and surgery ??which had the best survival outcomes ??were more likely to be in better health and have less-advanced cancer and higher-functioning livers than the patients who had other treatment. This is particularly true for transplantation, as there are stringent criteria for which patients are eligible, in particular regarding the size of the tumor, he added.

Commenting on the findings at the press briefing, which he moderated, Charles Staley, MD, from Emory University, in Atlanta, Georgia, said that transplantation has become the favored treatment for liver cancer because of the high rate of recurrence. "Even if you cut out the first tumor, a second tumor appears within about 6 to 7 months," he said, adding that "the liver appears to be defective in these patients, and the best option is to remove it completely."

However, Dr. Staley also highlighted the use of ablation in liver cancer, as "this procedure now offers a treatment for patients who previously had none." Although this review suggests ablation is "a little less successful" than the other options, he pointed out that the patients who undergo ablation have worse disease and a worse patient performance, and so it is unfair to compare treatments directly, as they are being used in different patient populations. Dr. Schwarz agreed, pointing out that the patients who underwent ablation "were too ill to undergo transplantation or surgery, so I don't see this as disappointing but rather as a good result, as these patients received ablation rather than no treatment." At present, ablation is palliative rather than curative, he commented, "but as the technique develops we may start to see better survival data." He also noted that there has been a steady increase in the use of this technique in recent years, up from its use in about 3% of patients in the SEER database they studied, which had 2003 as the cutoff date.


2007 GCS: Abstract 105. Presented January 20, 2007.