Ueshima Kazuomi, Ogasawara Sadahisa, Ikeda Masafumi, Yasui Yutaka, Terashima Takeshi, Yamashita Tatsuya, Obi Shuntaro, Sato Shinpei, Aikata Hiroshi, Ohmura Takumi, Kuroda Hidekatsu, Ohki Takamasa, Nagashima Kengo, Ooka Yoshihiko, Takita Masahiro, Kurosaki Masayuki, Chayama Kazuaki, Kaneko Shuichi, Izumi Namiki, Kato Naoya, Kudo Masatoshi, Omata Masao
Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Liver Cancer. 2020 Sep;9(5):583-595. doi: 10.1159/000508724. Epub 2020 Jul 24.
Prior to the approval of sorafenib, hepatic arterial infusion chemotherapy (HAIC) was offered to patients with advanced hepatocellular carcinoma (HCC) in East Asia, particularly Japan. According to the Japanese guidelines, HAIC is recommended as one of the treatment options in patients without extrahepatic metastasis (EHM).
The present cohort study compared the use of HAIC and sorafenib on outcomes of patients with advanced HCC. Consecutive patients with advanced HCC who received HAIC or sorafenib as a first-line systemic therapy were enrolled from 10 Japanese institutions. The primary outcomes were overall survival (OS) in patients with macrovascular invasion (MVI), but without EHM, and OS in patients without both MVI and EHM.
Between 2009 and 2016, 2,006 patients were enrolled (541 HAIC patients, 1,465 sorafenib patients). After propensity score matching, the OS of patients with MVI but without EHM was significantly longer in the HAIC group compared with the sorafenib group (10.1 vs. 9.1 months for the HAIC and sorafenib groups, respectively; = 170 for each group; hazard ratio [HR] 0.668; 95% confidence interval [95% CI] 0.475-0.935; = 0.018). There was no significant difference in OS between patients without both MVI and EHM (12.2 vs. 15.4 months for the HAIC and sorafenib groups, respectively; = 76 in each cohort after propensity score matching; HR 1.227; 95% CI 0.699-2.155; = 0.475).
HAIC is a potential front-line treatment choice in a subpopulation of patients with advanced HCC with MVI but without EHM.
在索拉非尼获批之前，东亚地区，尤其是日本，会为晚期肝细胞癌（HCC）患者提供肝动脉灌注化疗（HAIC）。根据日本指南，HAIC被推荐作为无肝外转移（EHM）患者的治疗选择之一。
本队列研究比较了HAIC和索拉非尼对晚期HCC患者结局的影响。从10家日本机构连续纳入接受HAIC或索拉非尼作为一线全身治疗的晚期HCC患者。主要结局是有大血管侵犯（MVI）但无EHM患者的总生存期（OS），以及既无MVI也无EHM患者的OS。
2009年至2016年期间，共纳入2006例患者（541例接受HAIC治疗的患者，1465例接受索拉非尼治疗的患者）。倾向评分匹配后，有MVI但无EHM患者的OS在HAIC组显著长于索拉非尼组（HAIC组和索拉非尼组分别为10.1个月和9.1个月；每组n = 170；风险比[HR] 0.668；95%置信区间[95% CI] 0.475 - 0.935；P = 0.018）。既无MVI也无EHM患者的OS无显著差异（HAIC组和索拉非尼组分别为12.2个月和15.4个月；倾向评分匹配后每组队列n = 76；HR 1.227；95% CI 0.699 - 2.155；P = 0.475）。
HAIC是晚期HCC有MVI但无EHM亚组患者潜在的一线治疗选择。
