RESUMO
Background/Aims@#Several treatment options are currently available for patients with hepatocellular carcinoma (HCC) failing previous sorafenib treatment. We aimed to compare the effectiveness of regorafenib and nivolumab in these patients. @*Methods@#Consecutive HCC patients who received regorafenib or nivolumab after failure of sorafenib treatment were included. Primary endpoint was overall survival (OS) and secondary endpoints were time to progression, tumor response rate, and adverse events. Inverse probability of treatment weighting (IPTW) using the propensity score was conducted to reduce treatment selection bias. @*Results@#Among 150 study patients, 102 patients received regorafenib and 48 patients received nivolumab. Median OS was 6.9 (95% confidence interval [CI], 3.0–10.8) months for regorafenib and 5.9 (95% CI, 3.7–8.1) months for nivolumab (P=0.77 by log-rank test). In multivariable analysis, nivolumab was associated with prolonged OS (vs. regorafenib: adjusted hazard ratio [aHR], 0.54; 95% CI, 0.30–0.96; P=0.04). Time to progression was not significantly different between groups (nivolumab vs. regorafenib: aHR, 0.82; 95% CI, 0.51–1.30; P=0.48). HRs were maintained after IPTW. Objective response rates were 5.9% and 16.7% in patients treated with regorafenib and nivolumab, respectively (P=0.04). @*Conclusions@#After sorafenib failure, the use of nivolumab may be associated with improved OS and better objective response rate as compared to using regorafenib.
RESUMO
BACKGROUND: Primary varicose veins are caused by a retrograde blood flow and increased hydrostatic pressure as a result of an increase in height or in physical strain associated with work. Treatment for varicose vein involves 1) conservative management - periodic leg elevation, elastic stocking support, and exercise with stocking support, 2) sclerotherapy, and 3) surgery. METHODS: Ninety-two limbs with primary varicose veins of the lower limb were operated on from Jan. 1996 to Dec. 1996. RESULTS: The prevalent age group consisted of those patients between 50 and 60 years old, and the female to male ratio was 2 : 1. Varicose veins developed in the right lower limb in 48 cases, in the left lower limb in 37 cases, and in both lower limbs in 7 cases. Presumed etiological factors included occupations requiring long periods of standing in 13 male cases, and pregnancy in 26 female cases. The average duration of illness was 12.5 8.6 years. Of the 92 cases operated on, a greater saphenous vein (GSV) high ligation (HL) and above knee (AK) stripping with varicosectomy (VS) was done in 38 cases, a GSV HL and total stripping with VS in 4 cases, a short saphenous vein (SSV) HL and VS in 14 cases, an external banding valvuloplasty of GSV and VS in 29 cases, an external banding valvuloplasty only in 2 cases, a Linton's operation in 2 cases, a GSV branch ligation and VS in 1 case, and sclerotherapy in 2 cases. The reduction rates of venous volume (VV) and ambulatory venous pressure (AVP) were 15 19% and 33 33%, respectively, after stripping. The reduction rates of VV and AVP were 19 18% and 33 36%, respectively, after valvuloplasty. Postoperative complications were wound complication in 1 case in the AK stripping group; postoperative numbness in 3 cases and wound complication in 1 case in the total stripping group; and wound complication in 1 case, GSV thrombosis in 2 cases, postoperative bleeding in 1 case, and postoperative reflux in 1 case in the valvuloplasty group. CONCLUSIONS: Generally, postoperative conditions were good and complications were negligible. In the stripping group, postoperative numbness developed only in the total stripping group. Between the valvuloplasty and the stripping groups, there was no significant hemodynamic difference.