肝细胞癌的区域治疗方法:系统性审查和元分析
Krishnan R Patel1, Hari Menon2, Roshal R Patel3
1Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
JAMA network open
|November 27, 2024
概括
肝癌的局部区域疗法 (LRT) 不同有效. 基于手术的治疗提供了最好的结果,而基于栓塞的选择给非转移性肝细胞癌 (HCC) 带来了最糟糕的结果.
科学领域:
- 肝胆道医学 肝胆道医学
- 手术瘤学手术瘤学
- 干预性放射学 干预性放射学
背景情况:
- 地方区域疗法 (LRT) 对非转移性肝细胞癌 (HCC) 是至关重要的.
- 需要对LRT疗效进行全面的比较,以指导临床决策.
- 现有的数据缺乏各种LRT的直接元分析比较.
研究的目的:
- 系统地审查和比较所有可用的LRTs对非转移性HCC的疗效.
- 进行随机临床试验 (RCT) 的直接,双向元分析.
- 建立局部HCC治疗有效性的层次结构.
主要方法:
- 系统搜索PubMed和主要瘤学会议记录 (2010-2023年).
- 包括评估LRT的RCT:手术,射频切除 (RFA),微波切除 (MWA),放射治疗 (RT),肝动脉输液化疗 (HAIC),跨动脉平淡栓塞 (TAE),跨动脉化学栓塞 (TACE) 和跨动脉放射栓塞 (TARE).
- 随机效应元分析比较治疗类别,分别将无进展生存率 (PFS) 和总生存率 (OS) 作为主要和次要结局.
主要成果:
- 分析了40个RCT,涉及11576名局部HCC患者.
- 与辅助治疗一起进行的手术与单独进行手术相比,显示出更好的PFS和OS.
- 手术表现优于RFA,RT显示出比TACE更好的结果,HAIC优于TACE.
- 没有观察到显著的异质性,除了RT与氨酸激酶抑制剂.
结论:
- 针对局部性HCC的LRTs在有效性方面并不相等.
- 治疗有效性的清晰层次存在.
- 基于手术的治疗提供了最好的结果,而基于栓塞的治疗与最差的结果有关.
相关概念视频
02:49Cancer Therapies
7.6K
Cancer therapies are various modes of treatment, such as surgery, radiation therapy, and chemotherapy that are administered to cancer patients.
However, cancer treatments can pose several challenges, as therapies used to kill cancer cells are generally also toxic to normal cells. Moreover, cancer cells mutate rapidly and can develop resistance to chemical agents or radiation therapy. Besides, all types of cancer cells may not respond to the same therapy. Some cancer cells respond to one...
However, cancer treatments can pose several challenges, as therapies used to kill cancer cells are generally also toxic to normal cells. Moreover, cancer cells mutate rapidly and can develop resistance to chemical agents or radiation therapy. Besides, all types of cancer cells may not respond to the same therapy. Some cancer cells respond to one...
7.6K
02:57Targeted Cancer Therapies
7.5K
The targeted cancer therapies, also known as “molecular targeted therapies,” take advantage of the molecular and genetic differences between the cancer cells and the normal cells. It needs a thorough understanding of the cancer cells to develop drugs that can target specific molecular aspects that drive the growth, progression, and spread of cancer cells without affecting the growth and survival of other normal cells in the body.
There are several types of targeted therapies against...
There are several types of targeted therapies against...
7.5K