title: Active Treatments Prolong the Survival in Patients With Hepatocellular Carcinoma and Performance Status 3 or 4: A Propensity Score Analysis.
abstract: Best supportive care is suggested as the standard treatment for hepatocellular carcinoma (HCC) patients with performance status (PS) 3-4 by the Barcelona Clinic Liver Cancer (BCLC) system. To investigate the rationale of treatment allocation.
  
  
  METHODS
  A total of 2660 HCC patients were reviewed. One-to-one matched pairs between PS 3 and 4 patients receiving supportive care and anti-HCC treatments were generated by using the propensity score with matching model. The survival analysis was performed with the Kaplan-Meier method and log-rank test. The hazard ratio was calculated with the Cox proportional hazards model.
  
  
  RESULTS
  Among 328 patients with PS 3-4, 38% of patients received active anti-HCC treatments against the BCLC system. Compared with patients undergoing supportive care, patients receiving anti-HCC treatments more often had milder cirrhosis, smaller tumor burden, and lower serum α-fetoprotein levels (all P<0.05). Patients undergoing supportive care had significantly decreased survival (P<0.0001). With propensity scores, 101 pairs of similar HCC patients with PS 3-4 were selected from different treatment groups. They were comparable in age, sex, etiologies of liver disease, severity of cirrhosis, tumor burden, and prevalence of diabetes mellitus (all P>0.05) at baseline. In the matching model, patients with PS 3-4 undergoing supportive care had significantly shortened survival with an adjusted hazard ratio of 4.711 (confidence interval: 3.041-7.297, P<0.0001).
  
  
  CONCLUSIONS
  Over one-third of patients with PS 3-4 receive active anti-HCC treatments against the BCLC allocation algorithm in this study. Active anticancer therapies rather than best supportive care should be performed if there is no apparent contraindication.
authors.affiliation: Departments of †Medicine ‡Surgery, Taipei Veterans General Hospital, Taipei, Taiwan *Faculty of Medicine §Institute of Clinical Medicine #Institute of Pharmacology, National Yang-Ming University School of Medicine ∥Queen of Angels Hospice, Arcadia, CA ¶Department of Pathology, University of Toronto, Toronto, Canada.
authors.forename: Chia-Yang
authors.initials: CY
authors.lastname: Hsu
authors.forename: Po-Hong
authors.initials: PH
authors.lastname: Liu
authors.forename: Yun-Hsuan
authors.initials: YH
authors.lastname: Lee
authors.forename: Cheng-Yuan
authors.initials: CY
authors.lastname: Hsia
authors.forename: Yi-Hsiang
authors.initials: YH
authors.lastname: Huang
authors.forename: Ya-Ju
authors.initials: YJ
authors.lastname: Tsai
authors.forename: Teddy S
authors.initials: TS
authors.lastname: Nagaria
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.forename: Teh-Ia
authors.initials: TI
authors.lastname: Huo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000188:drug therapy / Q000401:mortality*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D018579:Patient Selection; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012720:Severity of Illness Index; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000970:Antineoplastic Agents; D000509:alpha-Fetoproteins