李文利, 杜阳峰, 袁国盛, 臧梦雅, 朱培琳, 李榕, 陈泳如, 苏开妍, 李祺, 胡晓云, 庞桦进, 陈锦章. 经肝动脉化疗栓塞联合系统治疗对不可切肝细胞癌的疗效分析[J]. 中国肿瘤临床, 2023, 50(22): 1135-1141. DOI: 10.12354/j.issn.1000-8179.2023.20231001
引用本文: 李文利, 杜阳峰, 袁国盛, 臧梦雅, 朱培琳, 李榕, 陈泳如, 苏开妍, 李祺, 胡晓云, 庞桦进, 陈锦章. 经肝动脉化疗栓塞联合系统治疗对不可切肝细胞癌的疗效分析[J]. 中国肿瘤临床, 2023, 50(22): 1135-1141. DOI: 10.12354/j.issn.1000-8179.2023.20231001
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Wenli Li, Yangfeng Du, Guosheng Yuan, Mengya Zang, Peilin Zhu, Rong Li, Yongru Chen, Kaiyan Su, Qi Li, Xiaoyun Hu, Huajin Pang, Jinzhang Chen. Analysis of the therapeutic efficacy of transcatheter arterial chemoembolization combined with systemic treatment in unresectable hepatocellular carcinoma[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2023, 50(22): 1135-1141. DOI: 10.12354/j.issn.1000-8179.2023.20231001
Citation: Wenli Li, Yangfeng Du, Guosheng Yuan, Mengya Zang, Peilin Zhu, Rong Li, Yongru Chen, Kaiyan Su, Qi Li, Xiaoyun Hu, Huajin Pang, Jinzhang Chen. Analysis of the therapeutic efficacy of transcatheter arterial chemoembolization combined with systemic treatment in unresectable hepatocellular carcinoma[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2023, 50(22): 1135-1141. DOI: 10.12354/j.issn.1000-8179.2023.20231001
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经肝动脉化疗栓塞联合系统治疗对不可切肝细胞癌的疗效分析

Analysis of the therapeutic efficacy of transcatheter arterial chemoembolization combined with systemic treatment in unresectable hepatocellular carcinoma

    摘要
  • 摘要:
      目的  探索经肝动脉化疗栓塞（transcatheter arterial chemoembolization， TACE）为基础的不同方案治疗不可切除肝细胞癌（unresectable hepatocellular carcinoma，uHCC）患者的疗效和安全性，以及TACE联合酪氨酸激酶抑制剂（tyrosine kinase inhibitors，TKIs）和免疫检査点抑制剂（immune checkpoint inhibitors，ICIs）的最佳时机。
      方法  回顾性分析2016年4月至2021年12月期间在南方医科大学南方医院接受基于TACE治疗的555例uHCC患者资料。根据不同治疗方案分为：TACE组(n=317)、TACE+TKIs组(n=66)、TACE+ICIs组(n=33)、TACE+TKIs+ICIs组(n=139)。在亚组分析中，根据不同的联合时间将TACE+TKIs+ICIs组分为 “TACE前”和“TACE后”组。采用单因素、多因素Cox回归分析影响OS的预后因素。
      结果  TACE+TKIs+ICIs组获得最长的OS(21.9个月，95% CI: 17.2～26.6，P=0.030)和PFS(8.3个月，95% CI: 7.3～9.3，P=0.004)。在亚组分析中，“TACE后”组比“TACE前”组获得更长的OS(26.8个月vs.19.2个月，P=0.011)。 TACE组、TACE+TKIs组、TACE+ICIs组、TACE+TKIs+ICIs组的ORR分别为32.8%、41.1%、42.4%、52.5%（P=0.001），DCR分别为59.6%、71.2%、69.7%、82.7%（P<0.001）。不良反应事件与既往研究相似。Cox回归分析提示肿瘤数量、肝外转移及治疗方案是患者OS的独立预后因素（均P<0.05）。
      结论  TKIs或ICIs可以提高TACE治疗uHCC患者的OS和PFS，TKIs+ICIs联合TACE生存获益更佳。首次TACE术后3个月内联合“TKIs+ICIs”治疗方案的总生存期获益更显著。

     

    Abstract:
      Objective  To investigate the efficacy and safety of different transcatheter arterial chemoembolization (TACE)-based regimens in patients with unresectable hepatocellular carcinoma (uHCC) and explore the optimal timing for combining TACE with tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs).
      Methods  A retrospective analysis was conducted on data from 555 patients with uHCC who underwent TACE-based treatment between April 2016 and December 2021 in Nanfang Hospital, Southern Medical University. The patients were assigned into the following four groups according to different treatment regimens: TACE group (n=317), TACE combined with TKIs group (TACE+TKIs, n=66), TACE combined with ICIs group (TACE+ICIs, n=33), and TACE combined with TKIs+ICIs group (TACE+TKIs+ICIs, n=139). Subgroup analysis was performed within the TACE+TKIs+ICIs group, with patients being assigned into “pre-TACE” and “post-TACE” groups based on the timing of the combination therapy. Univariate and multivariate Cox regression analyses were conducted to identify prognostic factors influencing overall survival (OS).
      Results  The TACE+TKIs+ICIs group showed the longest OS (21.9 months, 95% confidence interval CI: 17.2−26.6, P=0.030) and progression-free survival (PFS) (8.3 months, 95% CI: 7.3−9.3, P=0.004) compared to those in the other three groups. In the subgroup analysis, the “post-TACE” group had longer OS than the “pre-TACE” group (26.8 months vs. 19.2 months, P =0.011). The objective response rate (ORR) was 32.8%, 41.1%, 42.4%, and 52.5% (P=0.001) and the disease control rate (DCR) was 59.6%, 71.2%, 69.7%, and 82.7% (P<0.001) in the TACE, TACE+TKIs, TACE+ICIs, and TACE+TKIs+ICIs groups, respectively. The adverse events were similar to those reported in previous studies. Cox regression analysis revealed that tumor number, extrahepatic metastasis, and treatment regimen were independent factors influencing OS in patients (all P<0.05).
      Conclusions  TKIs or ICIs can improve OS and PFS in patients with uHCC receiving TACE, and the combination of TKIs+ICIs with TACE achieves better beneficial outcomes. The greatest OS was observed when the combination therapy TKIs+ICIs was initiated within 3 months after the first TACE procedure.

     

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