Phương pháp điều trị và sống còn trên bệnh nhân ung thư biểu mô tế bào gan

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Tác giả: Mỹ Ngọc Chung, Thị Thu Cúc Trần, Hồng Minh Công Võ

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y Dược học Phạm Ngọc Thạch, 2023

Mô tả vật lý: tr.59

Bộ sưu tập: Metadata

ID: 339250

Thêm vào giỏ Liên kết toàn văn

- Mở đầu: Ung thư biểu mô tế bào gan (UTBMTBG) là một trong những loại ung thư phổ biến nhất toàn trên thế giới. Theo báo cáo của Tổ chức ghi nhận ung thư toàn cầu (GLOBOCAN) năm 2020 ghi nhận có thêm 905.677 ca bệnh mới và đứng hàng thứ 6 trong các loại ung thư ở cả hai giới. Với sự nỗ lực trong việc tầm soát phát hiện sớm bệnh và những tiến bộ mới trong phương pháp điều trị nhưng tỉ lệ tử vong của bệnh nhân UTBMTBG vẫn còn cao với tỉ lệ là 8,3%, đứng hàng thứ ba sau ung thư phổi và ung thư đại trực tràng.- Mục tiêu: Tỉ lệ sống còn 5 năm và ảnh hưởng của phương pháp điều trị lên sống còn 5 năm của bệnh nhân UTBMTBG.- Phương pháp nghiên cứu: Nghiên cứu đoàn hệ hồi cứu. Chúng tôi thu nhận 334 trường hợp UTBMTBG đến khám và điều trị tại bệnh viện Nhân dân Gia Định (BV NDGĐ) trong khoảng thời gian từ 01/01/2016 đến ngày 31/12/2020. Bệnh nhân được theo dõi ghi nhận các kết cục: sống, tử vong hoặc mất dấu theo dõi cho đến khi kết thúc nghiên cứu. Phân tích hồi quy Cox khảo sát mối liên quan giữa sống còn 5 năm với các phương pháp điều trị. Dữ liệu được phân tích trên phần mềm thống kê mã nguồn mở R phiên bản 3.2.5.- Kết quả: Tuổi trung bình trong nghiên cứu là 62,7 tuổi, bệnh nhân trẻ nhất là 29 tuổi và lớn tuổi nhất là 91 tuổi. Tỉ lệ Nam: Nữ là 3:1, với 262 bệnh nhân nam (78,4%) và 72 bệnh nhân nữ (21,6%). Nghiên cứu ghi nhận 103 trường hợp tử vong chiếm tỉ lệ 30,8%. Tỉ lệ sống còn 5 năm là 36,9% (KTC 95% 26,9 - 50,6%), tỉ lệ sống còn 3 năm là 58,7% (KTC 95% 51,7 - 66,6%), tỉ lệ sống còn 2 năm là 68,6% (KTC 95% 62,7 - 75%) và tỉ lệ sống còn 1 năm là 79,8% (KTC 95% 75 - 84,6%). Đa số các trường hợp trong mẫu nghiên cứu được điều trị bằng phương pháp TACE (37,3%) và phối hợp nhiều phương thức điều trị. Nhóm bệnh nhân chỉ điều trị chăm sóc giảm nhẹ có tỉ lệ tử vong cao, trong khi các bệnh nhân trong nhóm điều trị bằng phương pháp TACE, RFA, phẫu thuật và điều trị đa mô thức có tỉ lệ sống cao. Ngoài ra, ở nhóm bệnh nhân được điều trị bằng Sorafenib có tỉ lệ sống và tử vong là như nhau. Phối hợp đa mô thức (HR = 0,03, KTC95% 0,01 - 0,06
p <
0,01) và RFA (HR = 0,03
KTC 95% 0 - 0,22
p <
0,001) giúp giảm nguy cơ tử vong đáng kể so với điều trị giảm nhẹ.- Kết luận: Phối hợp điều trị đa mô thức và RFA giúp giảm nguy cơ tử vong đáng kể. Các trường hợp RFA là các trường hợp phát hiện bệnh ở giai đoạn sớm, điều này cho thấy rằng việc theo dõi các đối tượng nguy cơ UTBMTBG và phát hiện bệnh ở giai đoạn sớm đóng vai trò quan trọng trong tiên lượng sống còn UTBMTBG.Abstract- Background: Hepatocellular carcinoma (HCC) is one of the most common cancers in the world. According to the GLOBOCAN report in 2020, there were an estimated 905.677 new cases, ranking sixth among the most common cancers in both sexes. The 5 - year survival rate of individuals with HCC is still low despite several attempts in screening for early diagnosis of the disease and improvements in treatment methods.- Objectives: 5 - year survival rate and effect of treatment patterns on 5 - year survival in HCC.- Materials and Methods: In this retrospective cohort study, we examined the medical records of 334 HCC patients who were registered in Gia Định from January 1, 2016 to December 31, 2020. Patients were monitored for the following outcomes: survival, death, or loss of follow - up until the end of the study. Kaplan - Meier were used for examining the association between 5 - year survival and treatments by Cox regression. Data were analyzed on the open source statistical software R version 3.2.5.- Results: The youngest patient was 29 years old, while the oldest was 91 years old. The mean age was 62.7 years. With 262 male patients (78.4%) and 72 female patients (21.6%), the male: female ratio is 3:1. A total of 103 patients (30.8%) died. The 5 - year survival rate was 36.9% (95% CI 26.9 - 50.6%), the 3 - year survival rate was 58.7% (95% CI 51.7 - 66.6%), the 2 - year survival rate is 68.6% (95% CI 62.7 - 75%), the 1 - year survival rate is 79.8% (95% CI 75 - 84.6%). Most of the cases in the study sample were treated with TACE method (37.3%) and a combination therapy. The palliative care group had a high mortality rate, while the patients in the TACE, RFA, surgery, and multiple therapy groups had a high survival rate. In addition, in the group of patients treated with Sorafenib, survival and mortality were similar. Multiple therapy (HR = 0.03, 95% CI 0.01 - 0.06
p <
0.01) and RFA (HR = 0.03
95% CI 0 - 0.22
p <
0.001) significantly reduced the risk of death compared with palliative treatment.- Conclusion: The risk of death is greatly decreased by the combined therapy and RFA. RFA is a technique utilized for patients who are in the early stages of the disease, which demonstrates the importance of monitoring subjects who are at risk for developing HCC and early disease diagnosis in the outlook for HCC survival. DOI: 10.59715/pntjmp.2.2.8

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