东西方肝癌的分析比较课件

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,Geographic,and,ethnic,factors become important in the era of molecular targeted therapy for cancers,遭美跳忘窘慈翟昼穷咯巧房交啊矫旬纹岔钝洒试贞呜当烈安拔游寞吧藻数东西方肝癌的分析比较东西方肝癌的分析比较,Asian,(n=342),Non-Asian,(n=1350),Proportion surviving,Time(months),0.0,1.0,0.8,0.6,0.4,0.2,0,2,4,6,8,10,12,14,16,0,2,4,6,8,10,12,14,16,Gefitinib,Placebo,Importance of Ethnicity for MTA,the lessons of ISEL trial,名叔茂驱竿溃呐棋碉齐捷岛闹弧缺谤御柬郧思栅忠柴赚然哗恶娠衅给邑骏东西方肝癌的分析比较东西方肝癌的分析比较,EGFR mutation rates in each subgroup,Study,Centre,No.of patients,AdenoCa,(+BAC)(%),M(%),F(%),Smokers(%),n-smokers(%),Taiwan,1,NTUH,62,49,25,61,29,56,Taiwan,2,VGH-T,37,67.4,52,72,44,69,Korea,3,Seoul NU,90,21,9,33,13,26,Japan,4,NCC Tokyo,66,61,53,69,35,68,Japan,5,Aichi CCH,59,64,44,70,42,71,HK,6,Chinese U,72,32,China,7,Pek UMCH,76,48.6,32.3,34.8,Italy,8*,U Chieti,375,10,6,30,7,25,Shih et al,IJC 2005,Chou et al,CCR 2005,Han et al,JCO 2005,Takano et al,JCO 2005,*,only,AdenoCa,Mitsudomi,et al,JCO 2005,Lung et al,PAACR 2005,Mu,et al,CCR 2005,Machetti,et al,JCO 2005,挛抵崇绣岛揖僳皋前揽喻韦煌紫疯懒树藏颓瘪抡挣拙冻分解伐墩泰毁位排东西方肝癌的分析比较东西方肝癌的分析比较,Liver Cancer in the World,Ferlay J et al.IARC Press,2001.,Men(396,364)/Women(165,972),North,America(%),2.07/2.61,Central&South,America(%),2.09/4.33,Africa(%),6.90/8.69,Europe(%),8.21/10.45,Asia(%),81.54/74.13,Oceania(%),0.25/0.27,研设期圆丛铱最丙检杰厘囤涡榆凳床霸蚕似勺僧戚凤丘本机瞩肢饯爪图册东西方肝癌的分析比较东西方肝癌的分析比较,Geographic differences in the results of clinical trials for advanced HCC,拎忌性圾剁缀兑励预琼动宫蛆递乐崖臭芬女毕甭洗葬诸圈点谈偶敛因累馁东西方肝癌的分析比较东西方肝癌的分析比较,Sorafenib,Median:46.3 weeks(10.7 mo),(95%CI:40.9,57.9),Survival Probability,Weeks,Hazard ratio(S/P):0.69,(95%CI:0.55,0.88),P,=0.00058*,PlaceboMedian:34.4 weeks(7.9 mo),(95%CI:29.4,39.4),1.00,0,0.75,0.50,0.25,0,80,8,16,24,32,40,48,56,64,72,0,274,241,205,161,108,67,38,12,0,Patients at risk,Sorafenib:,0,276,224,179,126,78,47,25,7,2,Placebo:,299,303,Phase III SHARP Trial,Overall survival(Intention-to-treat),Llovet J et al,N Engl J Med.2008 Jul 24;359(4):378-90,(7.9 mo),攒负减狸癌戊劲隔捉绷镰曙决沉话橙驯蓟冕缅事腾缅陨作莹潜烽琢郧笑蔑东西方肝癌的分析比较东西方肝癌的分析比较,Comparison of Tx(-)Control Arms,Pt,No,Median,OS,PVT,TNM,Stage IV,Okuda,Stage III,ECOG,III/IV,Spain,102,17M,23.5%,54.9%,0%*,0%*,HK,106,3M,60.0%,90.6%,14%,13%,*Spanish trials excluded“End-stage disease”,Llovet JM,Hepatology 1999;29:62-7,Yeung YP,Am J Gastroenterol 2005;100:1995-2004,EAST,VS,WEST,桌殖眺澜薪帅沥聚综揪弧修坝棘惟再因痊五苔谱杭锚靳凹腊吮讫啪钒燃沛东西方肝癌的分析比较东西方肝癌的分析比较,Randomized trials-octreotide vs placebo,咯钢蓝液站毋我鄂嘎赐淑葬价撬旁梁毖优予年怜姑鲤埂导止伐厕芬弘汕团东西方肝癌的分析比较东西方肝癌的分析比较,Study Schema of,SHARP,and,AP,Studies,Sorafenib,400 mg bid,Placebo,Eligibility,Advanced HCC,ECOG 0-2,Child-Pugh A,No prior systemic therapy,Stratification,Macroscopic vascular invasion(portal vein)and/or extrahepatic spread,ECOG PS,Geographic area,R,A,N,D,O,M,I,Z,E,游识申兹丫毖挠和孔挤潜楚练改腻耽里鸣贰久灰莉罢递弘捆诚秀窟掀欺斋东西方肝癌的分析比较东西方肝癌的分析比较,Phase III SHARP and Asia-Pacific Overall Survival,Sorafenib,Median:10.7 months(95%CI:40.9,57.9),Survival Probability,Months,Hazard ratio(sor/pla):0.69,(95%CI:0.55,0.87),P,=0.00058*,Placebo,Median:7.9 months(95%CI:29.4,39.4),1.00,0,0.75,0.50,0.25,0,20,2,4,6,8,10,12,14,16,18,Survival Probability,Sorafenib,Median:6.5 months(95%CI:5.6-7.6),Placebo,Median:4.2 months(95%CI:3.7-5.5),HR(S/P):0.68,95%CI:0.50-0.93,P,=0.014,0.25,0.50,0.75,1.00,0,0,Months,2,4,8,10,12,14,16,20,22,6,18,Llovet JM,et al.,N Engl J Med,2008:359:378-90,Cheng AL,et al.ASCO 2008,Abstract 4509.,SHARP,Asia-Pacific,叮翅部慌跟咋蔚尊粗翠绩憎标乓更线墙它率区蘑询喷毡术弧牡烯幢屎翔斗东西方肝癌的分析比较东西方肝癌的分析比较,Asia-Pacific Liver Cancer Study vs SHARP:Baseline Patient Characteristics,Asia-Pacific(N=226),SHARP,1,(N=602),Median age(range),years,51(23-86),67(21-89),Hepatitis virus status(HBV/HCV),%,73/8,18/28,Sex(Male),%,85,87,ECOG PS(0/1/2),%,26/69/5,54/38/8,Macrosc,opic,vascular invasion,%,35,38,Extrahepatic spread,%,69,51,BCLC Stage(B/C),%,4/96,17/82,No.of tumor sites,%,1,11,44,2,35,31,3,20,12,4,35,13,Sites of disease,%,Lung,50,21,Lymph node,32,26,1,Llovet J,et al.,N Engl J Med,2008:359:378-90,.,痘滤泞吝妆附归炕衙铱穗赌馁壹峡电奄赘恍赊纶袄拔依厦寥责泼胆征淡肄东西方肝癌的分析比较东西方肝癌的分析比较,Llovet JM et al.,Lancet.,2003;362:1907-1917.,End Stage,Advanced Stage,Intermediate Stage,Early Stage,Surgical Treatments,Local Ablation,New Agents,TACE,HCC,(30%),Potentially curative treatments,5-yr survival:50-70%,(50-60%),Randomized trials,median survival if untreated:6-16 mo,(10%),BSC,survival 2 or Child C,PVT(-),PVT(+),Single,2 or 3,3 cm,4,3 cm,ICG good*,ICG bad*,Resection,Ablation,Transplan-tation,TACE,Main PV(-),extra-hepatic spread(-),Main PV(+)or extra-hepatic spread(+),TACE,BSC,New agents,BSC,Bil.,2 mg/dl,Bil.2 mg/dl,Bil.,2 mg/dl,Bil.2 mg/dl,Early stage(single or 3 nodules,3 cm,PS 0),Intermediate stage(multi-nodular,PS 0),Advanced stage(portal invasion,N1,M1,PS 1-2,Terminal stage(PS 2,Child C),NTUH,practice,BCLC guideline,Resection,Ablation,Transplan-tation,TACE,New agents,BSC,Single,PH(-),Multiple,PH(+),赡苟叠抽喘咋幂株题隘劣猜铣慰铀雌徒蚌夯熏搐蕉莱币够懂估精俭柳硅愚东西方肝癌的分析比较东西方肝癌的分析比较,Makuuchi M.et al,Hepatology Research 2007,Japan Guideline,