BACKGROUND Sub-Saharan Africa(SSA)and Southeast Asia account for 80%of hepatocellular carcinoma(HCC)cases globally.Public healthcare systems in low-and middleincome countries often face significant economic constraint...BACKGROUND Sub-Saharan Africa(SSA)and Southeast Asia account for 80%of hepatocellular carcinoma(HCC)cases globally.Public healthcare systems in low-and middleincome countries often face significant economic constraints,resulting in limited treatment options.The objectives of this study were to identify factors associated with poor outcomes in patients with Barcelona Clinic Liver Cancer(BCLC)stage C and D undergoing transarterial chemoembolization(TACE)and to compare their outcomes to patients treated tyrosine kinase inhibitors(TKIs)or best supportive care(BSC)only.AIM To assess clinical outcomes and identify predictive factors that may facilitate the broader implementation of TACE in patients with advanced HCC within resource-constrained settings such as SSA.METHODS A single-center,retrospective cohort study was conducted to investigate the risk factors associated with the outcome of TACE in patients with BCLC stage C and D using univariate and multivariate regression analysis.Frequency matching was used to ensure comparable distributions of confounding factors across patients treated with TACE,TKIs,or BSC.Survival analysis was performed to compare outcomes among the matched groups.RESULTS Patients with BCLC stage C and D presenting with elevated gamma-glutamyl transferase levels or elevated aspartate aminotransferase levels or portal vein infiltration were identified as high-risk and demonstrated poor response to TACE treatment.In contrast,patients with BCLC stage C disease who lacked these highrisk features showed significantly longer overall survival when treated with TACE compared to those who received BSC or TKIs.CONCLUSION Gamma-glutamyl transferase levels,aspartate aminotransferase levels,and portal vein infiltration are critical risk factors to consider when determining treatment strategies for HCC patients in SSA.Patients without these factors can derive significant benefits from TACE as an alternative to BSC or TKIs.展开更多
基金Supported by International Centre for Genetic Engineering and BiotechnologyHarry Crossley Foundation at the University of Cape Town.
文摘BACKGROUND Sub-Saharan Africa(SSA)and Southeast Asia account for 80%of hepatocellular carcinoma(HCC)cases globally.Public healthcare systems in low-and middleincome countries often face significant economic constraints,resulting in limited treatment options.The objectives of this study were to identify factors associated with poor outcomes in patients with Barcelona Clinic Liver Cancer(BCLC)stage C and D undergoing transarterial chemoembolization(TACE)and to compare their outcomes to patients treated tyrosine kinase inhibitors(TKIs)or best supportive care(BSC)only.AIM To assess clinical outcomes and identify predictive factors that may facilitate the broader implementation of TACE in patients with advanced HCC within resource-constrained settings such as SSA.METHODS A single-center,retrospective cohort study was conducted to investigate the risk factors associated with the outcome of TACE in patients with BCLC stage C and D using univariate and multivariate regression analysis.Frequency matching was used to ensure comparable distributions of confounding factors across patients treated with TACE,TKIs,or BSC.Survival analysis was performed to compare outcomes among the matched groups.RESULTS Patients with BCLC stage C and D presenting with elevated gamma-glutamyl transferase levels or elevated aspartate aminotransferase levels or portal vein infiltration were identified as high-risk and demonstrated poor response to TACE treatment.In contrast,patients with BCLC stage C disease who lacked these highrisk features showed significantly longer overall survival when treated with TACE compared to those who received BSC or TKIs.CONCLUSION Gamma-glutamyl transferase levels,aspartate aminotransferase levels,and portal vein infiltration are critical risk factors to consider when determining treatment strategies for HCC patients in SSA.Patients without these factors can derive significant benefits from TACE as an alternative to BSC or TKIs.
