Hepatoselüler Kanser Hastalarında Uygulanan Tedavilerin Sağkalım Üzerine Etkilerinin Değerlendirilmesi
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Şahin H. Evaluation of the Effects of Treatment Modalities on Survival in Patients with Hepatocellular Carcinoma, Hacettepe University, Department of Internal Medicine, Thesis, Ankara, 2023. Hepatocellular carcinoma (HCC) is a disease characterized by high mortality, and currently, numerous studies are being conducted to explore treatment options and the efficacy of interventions. This study analyzes the effectiveness of surgical, ablative, transarterial chemoembolization, transarterial radioembolization (TARE), and systemic treatments on the survival duration of HCC patients, based on their demographic, clinical, laboratory, and imaging data, considering the existing literature. A total of 311 patients were included in this retrospective study, and their demographic and clinical characteristics, along with the treatment options they received, were examined and their survival was analyzed. The median cumulative survival time was found to be 21.5 months. Heavy alcohol consumption and smoking were found to have negative effects on survival, while other demographic and etiological factors showed no significant impact. Gastrointestinal bleeding history and the presence of hepatic encephalopathy were shown to have an adverse effect on survival. Moreover, abnormalities in laboratory parameters such as hemoglobin levels, sodium, albumin, platelet count, leukocyte count, neutrophil-to-lymphocyte ratio, blood urea nitrogen, potassium, alkaline phosphatase, gamma-glutamyl transferase, total and direct bilirubin, aspartate aminotransferase, alpha-fetoprotein, and sedimentation rate were demonstrated to affect survival (p<0.05). In radiological imaging, the presence of lesion count, tumor size, metastasis or lymphadenopathy, and satellite lesions were identified as significant prognostic factors for survival in our study. In patients' 1-year and 2-year follow-ups, it was shown that the negative impact of progressive disease within the first year had a greater effect on survival. Performance status and the albumin-bilirubin index were found to be significant in terms of survival. Among the evaluated scoring systems in our patient population, the Hong Kong Liver Cancer (HKLC) system was found to be more successful in determining survival (p=0.000) compared to others. Curative treatments were found to provide a significant survival advantage over non-curative treatments. The contribution of TARE, transarterial chemoembolization (TACE), and systemic chemotherapies to survival was lower (p=0.000). In the analysis where transplant patients were not included, the median survival in curative treatments was found to be 97.6 months (80.4-114.9), while in untreated patients, it was 3.6 months (1.4-5.7).