Hepatocelulárny karcinóm na strednom Slovensku – analýza kohorty 207 pacientov v nemocnici 3. stupňa

English version

Authors: L. Skladaný ¹; S. Adamcova-Selcanova ¹; V. Malec ²; J. Badinkova ¹; E. Pritzova ²; J. Janek ³; S. Okapec ⁴
Authors‘ workplace: HEGITO (Division of Hepatology, Gastroenterology and Liver Transplantation), Department of Internal Medicine II, Slovak Medical University, F. D. Roosevelt University Hospital, Banska Bystrica, Slovak Republic ¹; Department of Oncology, F. D. Roosevelt University Hospital, Banska Bystrica, Slovak Republic ²; Department of Surgery, F. D. Roosevelt University Hospital, Banska Bystrica, Slovak Republic ³; Department of Radiology, F. D. Roosevelt University Hospital, Banska Bystrica, Slovak Republic ⁴
Published in: Gastroent Hepatol 2018; 72(2): 99-107
Category: Hepatology: Original Article
doi: https://doi.org/10.14735/amgh201899

Overview

Úvod:
Vlastnosti hepatocelulárneho karcinómu (HCC) z rôznych geografických oblastí sú odlišné.

Cieľ:
Analyzovať kohortu pacientov v nemocnici 3. stupňa.

Metodológia:
Retrospektívna analýza za sebou idúcich pacientov. Vstupné kritériá: HCC; vylučovacie kritériá: nedostatok dát; interval: roky 2007–2016.

Výsledky:
Súbor 207 pacientov, 95 % s cirhózou, 76 % mužov; vek 62 rokov. Etiológia hepatálneho ochorenia: Alkohol (ALD) 106 (48 %), hepatitída C 17 %, hepatitída B 13 %, nealkoholová steatohepatitída 10 %, kryptogénna 7 %, necirhotická 4 %, iná 1 %. Diagnóza prostredníctvom surveillance 24 %, bez surveillance 67 %, neznámy spôsob diagnózy 9 %. Priemer ložiska pri diagnóze SUR-HCC 5 cm, bez SUR-HCC 8,6 cm (p = 0,001). BCLC štádium: A – 30 pacientov (15 %), B – 29 %, C – 36 %, D – 20 %; BCLC podľa diagnózy (SUR-HCC vs. non-SUR-HCC): A – 15/49 (31 %) vs. 12/140 (9 %), B 43 vs. 27 %, C – 16 vs. 39 %, D – 10 vs. 25 %. Terapia: Chirurgická resekcia 17 pacientov (7 %), transplantácia pečene 14 (6 %), rádiofrekvenčná ablácia 20 (8 %), transarteriálna chemoembolizácia 60 (24 %), sorafenib 88 (35 %), suportívna starostlivosť 46 (19 %), 3 pacienti sú čakateľmi na transplantaci pečene. Priemerné prežívanie 17 (0,06–112) mesiacov, prežívanie podľa BCLC: A – 37 (2–112), B – 21 (0,6–86), C – 14 (0,06–92), D – 3 (0,06–24) mesiacov.

Záver:
Demografické údaje v našej kohorte sú porovnateľné s krajinami západnej Európy a Severnej Ameriky. ALD bola najčastejšou etiológiou základného ochorenia pečene, 95 % pacientov malo cirhózu. Len 24 % pacientov bolo zachytených prostredníctvom SUR-HCC, preto bol zaznamenaný výrazný posun doprava v BCLC štádiách, čo viedlo k suboptimálnej alokácii radikálnej liečby a následne aj k horšiemu prežívaniu. Súhrnne sú tieto výsledky porovnateľné s údajmi z Európy a Severnej Ameriky.

Kľúčové slová:
hepatocelulárny karcinóm – kohorta – diagnóza – liečba – prežívanie – surveillance

Autoři deklarují, že v souvislosti s předmětem studie nemají žádné komerční zájmy.

Redakční rada potvrzuje, že rukopis práce splnil ICMJE kritéria pro publikace zasílané do biomedicínských časopisů.

Doručeno:
23. 10. 2017

Přijato:
25. 11. 2017

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