When to perform hepatic resection for intermediate‐stage hepatocellular carcinoma
Transcatheter arterial chemoembolization (TACE) is the first‐line therapy recommended for patients with intermediate hepatocellular carcinoma (HCC). However, in clinical practice, these patients are often referred to surgical teams to be evaluated for hepatectomy. After making a treatment decision (...
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Veröffentlicht in: | Hepatology (Baltimore, Md.) Md.), 2015-03, Vol.61 (3), p.905-914 |
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Format: | Artikel |
Sprache: | eng |
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Zusammenfassung: | Transcatheter arterial chemoembolization (TACE) is the first‐line therapy recommended for patients with intermediate hepatocellular carcinoma (HCC). However, in clinical practice, these patients are often referred to surgical teams to be evaluated for hepatectomy. After making a treatment decision (e.g., TACE or surgery), physicians may discover that the alternative treatment would have been preferable, which may bring a sense of regret. Under this premise, it is postulated that the optimal decision will be the one associated with the least amount of regret. Regret‐based decision curve analysis (Regret‐DCA) was performed on a Cox's regression model developed on 247 patients with cirrhosis resected for intermediate HCC. Physician preferences on surgery versus TACE were elicited in terms of regret; threshold probabilities (Pt) were calculated to identify the probability of survival for which physicians are uncertain of whether or not to perform a surgery. A survey among surgeons and hepatologists regarding three hypothetical clinical cases of intermediate HCC was performed to assess treatment preference domains. The 3‐ and 5‐year overall survival rates after hepatectomy were 48.7% and 33.8%, respectively. Child‐Pugh score, tumor number, and esophageal varices were independent predictors of survival (P |
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ISSN: | 0270-9139 1527-3350 |
DOI: | 10.1002/hep.27321 |