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Köstek O, Demirel A, Hacıoğlu MB, Tastekin D, Karabulut S, Gündogdu A, Sever N, Ayhan M, Çelebi A, Majidova N, Yaşar A, Ağyol Y, Erel P, Kocaaslan E, Güren AK, Arıkan R, Isık S, Ercelep O, Goksu SS, Alandag C, Bilgetekin İ, Caner B, Sahin AB, Gulmez A, Akagunduz B, Kose F, Kaplan MA, Dogan E, Sakalar T, Guven DC, Gurbuz M, Ergun Y, Karaagac M, Turker S, Ozkul O, Yıldız B, Sahin S, Demiray AG, Sari M, Erdogan B, Hacıbekiroglu İ, Çakmak Öksüzoğlu ÖB, Kilickap S, Bilici A, Bayoglu İV, Topaloglu S, Cicin İ. The prognostic factors in patients with advanced hepatocellular carcinoma: impact of treatment sequencing. J Chemother 2024:1-9. [PMID: 38263804 DOI: 10.1080/1120009x.2024.2305066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Abstract
The prognosis of patients with advanced HCC can vary widely depending on factors such as the stage of the cancer, the patient's overall health, and treatment regimens. This study aimed to investigate survival outcomes and associated factors in patients with hepatocellular carcinoma (HCC). In this retrospective study, data from 23 medical oncology clinics were analyzed. Progression-free survival (PFS) and overall survival (OS) values were estimated using the Kaplan-Meier method. Prognostic factors associated with survival which were identified in univariate analysis were subsequently evaluated in a multivariate Cox-regression survival analysis was conducted using the backward stepwise (Conditional LR) method to determine the independent predictors of PFS and OS. Of 280 patients, 131 received chemotherapy and 142 received sorafenib, 6 received atezolizumab plus bevacizumab and 1 received nivolumab for first-line setting. The median follow-up time was 30.4 (95%CI 27.1-33.6) months. For-first line, median PFS was 3.1 (95%CI2.7-3.5) months, and it was significantly longer in patients who received sorafenib or atezolizumab-bevacizumab or nivolumab (PFS 5.8 (95%CI 4.2-7.5) than in those received chemotherapy (PFS 2.1 (95%CI 1.9-2.3) in the first-line setting (p < 0.001). Multivariate analysis revealed that male gender (HR: 2.75, 95% CI: 1.53-4.94, p = 0.01), poor ECOG performance score (HR: 1.88, 95% CI: 1.10-3.21, p = 0.02), higher baseline AFP level (HR: 2.38, 95% CI: 1.54-3.67, p < 0.001) and upfront sorafenib treatment (HR,0.38; 95% CI: 0.23-0.62, p < 0.001) were significantly associated with shorter PFS. The median OS was 13.2 (95%CI 11.1-15.2) months. It was significantly longer in patients who received sorafenib or atezolizumab-bevacizumab or nivolumab in the first-line setting followed by TKIs (sorafenib or regorafenib, OS 18.6 (95%CI 13.8-23.5)) compared to those who received chemotherapy (OS 10.3 (95%CI 6.6-14.1)) in the first-line setting. The multivariate analysis revealed that upfront chemotherapy treatment approach, male gender (HR: 1.77, 95% CI: 1.07-2.94, p = 0.02), poor ECOG performance score (HR: 1.96, 95% CI: 1.24-3.09, p = 0.004) and Child-Pugh score, presence of extrahepatic disease (HR: 1.54, 95% CI: 1.09-2.18, p = 0.01), and higher baseline AFP value (HR: 1.50, 95% CI: 1.03-2.19, p = 0.03) were significantly associated with poor prognosis. Additionally, regarding of treatment sequence, upfront sorafenib followed by regorafenib showed a significantly lower risk of mortality (HR: 0.40, 95% CI: 0.25-0.66, p < 0.001). Sorafenib followed by regorafenib treatment was associated with a significantly lower risk of mortality rather than upfront sorafenib followed by BSC group or upfront chemotherapy followed by TKIs. These findings underscore the importance of the optimal treatment sequences to improve survival in patients with advanced HCC.
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Affiliation(s)
- Osman Köstek
- Department of Medical Oncology, Marmara University, Istanbul, Turkiye
| | - Ahmet Demirel
- Department of Medical Oncology, Marmara University, Istanbul, Turkiye
| | | | - Didem Tastekin
- Department of Medical Oncology, Istanbul University, Istanbul, Turkiye
| | - Senem Karabulut
- Department of Medical Oncology, Istanbul University, Istanbul, Turkiye
| | - Abidin Gündogdu
- Department of Medical Oncology, Marmara University, Istanbul, Turkiye
| | - Nadiye Sever
- Department of Medical Oncology, Marmara University, Istanbul, Turkiye
| | - Murat Ayhan
- Clinic of Medical Oncology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkiye
| | - Abdussamed Çelebi
- Department of Medical Oncology, Marmara University, Istanbul, Turkiye
| | - Nargiz Majidova
- Department of Medical Oncology, Marmara University, Istanbul, Turkiye
| | - Alper Yaşar
- Department of Medical Oncology, Marmara University, Istanbul, Turkiye
| | - Yeşim Ağyol
- Department of Medical Oncology, Marmara University, Istanbul, Turkiye
| | - Pınar Erel
- Department of Medical Oncology, Marmara University, Istanbul, Turkiye
| | - Erkam Kocaaslan
- Department of Medical Oncology, Marmara University, Istanbul, Turkiye
| | - Ali Kaan Güren
- Department of Medical Oncology, Marmara University, Istanbul, Turkiye
| | - Rukiye Arıkan
- Department of Medical Oncology, Marmara University, Istanbul, Turkiye
| | - Selver Isık
- Department of Medical Oncology, Marmara University, Istanbul, Turkiye
| | - Ozlem Ercelep
- Department of Medical Oncology, Marmara University, Istanbul, Turkiye
| | - Sema Sezgin Goksu
- Department of Medical Oncology, Antalya University, Antalya, Turkiye
| | - Celal Alandag
- Department of Medical Oncology, Cumhuriyet University, Sivas, Turkiye
| | - İrem Bilgetekin
- Dr Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Turkiye
| | - Burcu Caner
- Department of Medical Oncology, Uludag University, Bursa, Turkiye
| | | | - Ahmet Gulmez
- Faculty of Medicine, Department of Medical Oncology, Inonu University, Malatya, Turkey
| | - Baran Akagunduz
- Clinic of Medical Oncology, Mengucekgazi Training and Research Hospital, Erzincan, Turkiye
| | - Fatih Kose
- Department of Medical Oncology, Baskent University, Adana, Turkiye
| | | | - Ender Dogan
- Department of Medical Oncology, Erciyes University, Kayseri, Turkiye
| | - Teoman Sakalar
- Department of Medical Oncology, Erciyes University, Kayseri, Turkiye
| | - Deniz Can Guven
- Department of Medical Oncology, Hacettepe University, Ankara, Turkiye
| | - Mustafa Gurbuz
- Department of Medical Oncology, Ankara University, Ankara, Turkiye
| | - Yakup Ergun
- Department of Medical Oncology, Ankara Numune Training and Research Hospital, Ankara, Turkiye
| | - Mustafa Karaagac
- Department of Medical Oncology, Necmettin Erbakan University, Konya, Turkiye
| | - Sema Turker
- Clinic of Medical Oncology, Ankara Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkiye
| | - Ozlem Ozkul
- Department of Medical Oncology, Sakarya University, Sakarya, Turkıye
| | - Birol Yıldız
- Department of Medical Oncology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Süleyman Sahin
- Department of Medical Oncology, Van Education and Research Hospital, Van, Turkey
| | | | - Murat Sari
- Department of Medical Oncology, Marmara University, Istanbul, Turkiye
| | - Bülent Erdogan
- Department of Medical Oncology, Trakya University, Istanbul, Turkiye
| | | | | | | | - Ahmet Bilici
- Department of Medical Oncology, Medipol University, Istanbul, Turkiye
| | | | - Sernaz Topaloglu
- Department of Medical Oncology, Trakya University, Istanbul, Turkiye
| | - İrfan Cicin
- Department of Medical Oncology, Trakya University, Istanbul, Turkiye
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Resende V, Tsilimigras DI, Endo Y, Guglielmi A, Ratti F, Aldrighetti L, Marques HP, Soubrane O, Lam V, Poultsides GA, Popescu I, Alexandrescu S, Gleisner A, Martel G, Hugh T, Endo I, Shen F, Pawlik TM. Machine-Based Learning Hierarchical Cluster Analysis: Sex-Based Differences in Prognosis Following Resection of Hepatocellular Carcinoma. World J Surg 2023; 47:3319-3327. [PMID: 37777670 DOI: 10.1007/s00268-023-07194-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Patients with hepatocellular carcinoma (HCC) may have a heterogeneous presentation, as well as different long-term outcomes following surgical resection. We sought to use machine learning to cluster patients into different prognostic groups based on preoperative characteristics. METHODS Patients who underwent curative-intent liver resection for HCC between 2000 and 2020 were identified from a large international multi-institutional database. A hierarchical cluster analysis was performed based on preoperative factors to characterize patterns of presentation and define disease-free survival (DFS). RESULTS Among 966 with HCC, 3 distinct clusters were identified: Cluster 1 (n = 160, 16.5%), Cluster 2 (n = 537, 55.6%) and Cluster 3 (n = 269, 27.8%). Cluster 1 (n = 160, 16.5%) consisted of female patients (n = 160, 100%), low inflammation-based scores, intermediate tumor burden score (TBS) (median: 4.71) and high alpha-fetoprotein (AFP) levels (median 41.3 ng/mL); Cluster 2 consisted of male individuals (n = 537, 100%), mainly with a history of HBV infection (n = 429, 79.9%), low inflammation-based scores, intermediate AFP levels (median 26.0 ng/mL) and lower TBS (median 4.49); Cluster 3 was comprised of older patients (median age 68 years) predominantly male (n = 248, 92.2%) who had low incidence of HBV/HCV infection (7.1% and 8.2%, respectively), intermediate AFP levels (median 16.8 ng/mL), high inflammation-based scores and high TBS (median 6.58). Median DFS worsened incrementally among the three different clusters with Cluster 3 having the lowest DFS (Cluster 1: median not reached; Cluster 2: 34 months, 95% CI 23.0-48.0, Cluster 3: 19 months, 95% CI 15.0-29.0, p < 0.05). CONCLUSION Cluster analysis classified HCC patients into three distinct prognostic groups. Cluster assignment predicted DFS following resection of HCC with the female cluster having the most favorable prognosis following HCC resection.
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Affiliation(s)
- Vivian Resende
- Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
- Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil
| | - Diamantis I Tsilimigras
- Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Yutaka Endo
- Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | | | | | | | - Hugo P Marques
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | - Olivier Soubrane
- Department of Hepatobiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France
| | - Vincent Lam
- Department of Surgery, Westmead Hospital, Sydney, Australia
| | | | - Irinel Popescu
- Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | | | - Ana Gleisner
- Department of Surgery, University of Colorado, Denver, CO, USA
| | | | - Tom Hugh
- Department of Surgery, School of Medicine, The University of Sydney, Sydney, Australia
| | - Itaru Endo
- Yokohama City University School of Medicine, Yokohama, Japan
| | - Feng Shen
- Eastern Hepatobiliary Surgery Hospital Second Military Medical University, Shanghai, China
| | - Timothy M Pawlik
- Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
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