东西方肝癌地分析比较.ppt

Comparative Analyses of Hepatocellular Carcinoma between East and West ─ Implication on the design of clinical trials Geographic and ethnic factors become important in the era of molecular targeted therapy for cancers EGFR mutation rates in each subgroup Liver Cancer in the World Geographic differences in the results of clinical trials for advanced HCC Phase III SHARP TrialOverall survival (Intention-to-treat) Comparison of Tx(-) Control Arms Randomized trials - octreotide vs placebo Study Schema of SHARP and AP Studies Phase III SHARP and Asia-Pacific Overall Survival Asia-Pacific Liver Cancer Study vs SHARP:Baseline Patient Characteristics HCC treatment schedule ( BCLC ) Meta-analysis of Phase III clinical Trials of HCC Databases Medline, Cancerlit, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effect, and ASCO Proceedings, 2005 – 2007 Articles/abstracts published Jan 1996 to Jun 2007 Trials registered at that have completed patient recruitment Keywords: ‘Hepatocellular carcinoma’ OR ‘liver cancer’ OR ‘HCC’ ‘Randomized controlled trial’ OR ‘randomized controlled study’ Inclusion criteria Randomized controlled trials of systemic therapy for HCC patients who were not resectable and not suitable for local therapy (TACE, PEIT, etc.) Placebo/supportive care as the control arm Meta-regression: Predictors of survival of the control group patients (1) Geographic differences in the etiology of HCC implication in the development of MTAs Etiology of HCC— Distinct Geographic Distribution Is HBV-related HCC a more aggressive tumor ? Is HBV-related HCC associated with molecular changes which affect molecular therapy ? HCC ─ East vs West Long-term results after surgical treatment were similar in West and East when clinicopatnologic factors were accounted for. Pawlik TM et al Liver Transplantation 2004;10(suppl 1) 74-80 Taeck D et al Liver Transplantation 2004;10(suppl 1) 58-63 HBV vs. H