Addressing the Interplay of Liver Disease and Hepatocellular Carcinoma on Patient Survival: The ALBI Scoring Model
Menée sur 1 313 patients atteints d'un carcinome hépatocellulaire, puis validée sur 6 754 autres patients et 501 patients atteints d'une maladie hépatique chronique autre que le carcinome hépatocellulaire, cette étude évalue la performance d'un système de score, basé sur les niveaux sériques de bilirubine et d'albumine, pour évaluer la fonction hépatique
Hepatocellular carcinoma (HCC) is a complex disorder with a poor overall prognosis.In most cases, it presents on a background of chronic liver disease, and the interplay of the underlying liver disease and the cancer itself drives treatment decisions. The clinician must consider factors such as the stage and extent of tumor, the underlying liver function, and the patient's performance status. There is a clear need for staging systems to best guide therapeutic approaches, but the lack of a universally accepted prognostic system has been problematic. Treatment guidelines vary in different countries or regions of the globe and may be influenced by the staging system accepted. In addition, despite advances in surveillance programs of at-risk populations leading to curative treatments for early disease, the reality is that we are faced with growing numbers of patients presenting with advanced or recurrent incurable HCC. Progress in the field of advanced HCC has been slow and modest. We have been successful in accruing patients globally and completing both early- and late-phase therapeutic trials, yet most phase III trials in advanced HCC have been negative. We are at a point when we need to re-evaluate some of our assumptions. Staging and its impact on trial eligibility is one place to start. The evaluation of liver function within HCC patient populations as part of staging is the focus of the article by Johnson et al that accompanies this editorial.
Journal of Clinical Oncology , éditorial en libre accès, 2014