Real-world treatment patterns, clinical outcomes, and health care resource utilization in advanced unresectable hepatocellular carcinoma.
Notice bibliographique
Résumé
400 Background: The incidence of advanced unresectable hepatocellular carcinoma (HCC) is increasing in several developed countries and the prognosis of advanced HCC remains poor. Real-world evidence of treatment patterns and patient outcomes can highlight the unmet clinical need within this population. Methods: We conducted a retrospective population-based cohort study of advanced unresectable HCC patients diagnosed in Alberta, Canada between 2008-2018 using electronic medical records and administrative claims data. A chart review was conducted among patients treated with systemic therapy to capture additional treatment information that is not available in the administrative data. The objectives of this study were to describe the treatment patterns, overall survival, and healthcare resource utilization of advanced HCC patients. Results: A total of 1,297 advanced HCC patients were included in this study, of which 555 (42.8%) were recurrent cases and the remainder were advanced unresectable cases at diagnosis. Median age at diagnosis was 64 (range: 21-94) and 82.1% were men. Only 274 patients (21.1%) received first-line systemic therapy and of those 32 patients (11.7%) initiated second-line therapy. Nearly all of the patients treated with systemic therapy received sorafenib (> 96.4%) in first-line and over half of these patients (55.8%) had a dose reduction during the course of treatment. Patients who received systemic therapy had considerably higher median overall survival (12.23 months; 95% CI: 10.72-14.10) compared to patients not treated with systemic therapy (2.66 months; 95% CI: 2.33-3.12; log-rank p-value < 0.001). Among patients who received first-line systemic therapy, the 2-year and 5-year survival rates were 17.9% (95% CI: 13.7-23.4) and 3.9% (95% CI: 1.8-8.6), respectively. Among patients treated with systemic therapy, overall survival was highest for recurrent cases, patients with Child-Pugh A, patients with hepatitis C virus or multiple known HCC risk factors, and for recurrent patients who received transarterial chemoembolization and ablation (separate procedures) in early stage (log-rank: p < 0.05). No significant differences in survival were observed for dose reduction in first-line therapy, age group, sex, the presence of cirrhosis, or the presence of metastatic disease (log-rank: p > 0.05). Among patients that received first-line systemic therapy, the average time spent in hospital was 9, 9, and 8 days per patient within years 1, 2, and 3, respectively. Conclusions: In a Canadian real-world setting, patients who received systemic therapy had considerably greater survival than those who did not, but the initiation rate was low and dose reductions were common. The low uptake of systemic therapy and the modest survival gains highlight the importance of earlier diagnosis and the need for novel and more effective first-line therapies.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».