在肝细胞癌全身治疗期间,确定肝衰减是有意义的临床结果
Giuseppe Cabibbo1, Ciro Celsa2, Sherrie Bhoori3
1Gastroenterology and Hepatology Unit, Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, University of Palermo, Italy.
对于晚期肝细胞癌 (HCC),肝功能障碍显著影响患者的结果,而不是瘤生长. 管理肝脏健康对于改善HCC患者的预后至关重要,特别是在新的免疫疗法中.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 在瘤学瘤学.
- 临床医学 临床医学
背景情况:
- 晚期肝细胞癌 (HCC) 的预后取决于瘤进展和肝功能障碍.
- 肝衰竭事件显著恶化HCC患者的预后,往往比瘤进展本身更严重.
- 对于肝功能较差的患者,可以给HCC提供有效的免疫疗法,从而增加脱补偿风险.
研究的目的:
- 突出肝脏衰竭在HCC预后中的关键作用.
- 倡导实用策略,预防和管理HCC患者的脱补偿.
- 建议在未来的HCC临床试验中将肝衰减作为关键终点纳入.
主要方法:
- 审查肝脏衰减与瘤进展对HCC结局的影响的证据.
- 识别潜在肝病的诊断过程和脱补偿的危险因素.
- 讨论管理策略,包括非选择性β-阻断剂和肝硬化病的病因治疗方法.
主要成果:
- 肝衰退是一个比晚期HCC的瘤进展更强的预后因素.
- 患有较高的白蛋白-白素 (ALBI) 度和门性高血压指标的患者面临着高危的脱补偿.
- 当前的治疗模式可能无法充分解决瘤和肝脏疾病的双重影响.
结论:
- 需要对HCC采取综合,多方面的治疗方法,同时解决肝病和癌症.
- 肝衰竭应该是临床上有意义的HCC试验中的二次终点,以更好地评估全身疗法.
- 优化患者的治疗结果需要在癌症治疗的同时管理潜在的肝病.
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