肝动脉灌注化疗与索拉非尼治疗肝动脉同期放化疗后晚期肝细胞癌的疗效比较。

Treatment efficacy by hepatic arterial infusion chemotherapy vs. sorafenib after liver-directed concurrent chemoradiotherapy for advanced hepatocellular carcinoma.

机构信息

Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.

Yonsei Liver Center, Severance Hospital, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.

出版信息

J Cancer Res Clin Oncol. 2021 Oct;147(10):3123-3133. doi: 10.1007/s00432-021-03632-4. Epub 2021 Apr 23.

DOI:10.1007/s00432-021-03632-4

PMID:33893539

Abstract

BACKGROUND

We compared the clinical efficacies of hepatic arterial infusion chemotherapy (HAIC) vs. sorafenib as sequential maintenance therapy following liver-directed concurrent chemoradiotherapy (LD-CCRT) for locally advanced-stage hepatocellular carcinoma (HCC).

METHODS

Patients undergoing HAIC with 5-fluorouracil and cisplatin (HAIC-maintain group, n = 151) or sorafenib (Sorafenib-maintain group, n = 37) after LD-CCRT were consecutively enrolled. The study endpoints were overall survival (OS), progression-free survival (PFS), and treatment response rates.

RESULTS

The median OS among HAIC-maintain and Sorafenib-maintain groups were 15.9 and 24.3 months (p = 0.287), whereas the median PFS were 8.1 and 9.1 months (p = 0.651), respectively. During the planned treatments, the radiological objective response rate (54.3% vs. 64.9%; p = 0.246), and conversion rate to surgical resection or liver transplantation after successful down-staging (15.9% vs. 18.9%; p = 0.657) were comparable between the HAIC-maintain and Sorafenib-maintain groups. Similar results were found after the inverse probability of treatment weighting and propensity score-matching analyses. Regarding treatment-related adverse events, the HAIC-maintain group showed worse profiles in terms of leukopenia (all grades [p = 0.001] and grades 3 or 4 [p = 0.041]) and hypoalbuminemia (p = 0.001) than the Sorafenib-maintain group.

CONCLUSIONS

The overall clinical efficacies between the sequential treatment of HAIC vs. sorafenib after LD-CCRT were comparable for locally advanced HCC.

摘要

背景

我们比较了肝动脉灌注化疗（HAIC）与索拉非尼作为局部晚期肝细胞癌（HCC）肝定向同期放化疗（LD-CCRT）后序贯维持治疗的临床疗效。

方法

连续入组 LD-CCRT 后行 HAIC 联合氟尿嘧啶和顺铂（HAIC-维持组，n=151）或索拉非尼（Sorafenib-维持组，n=37）的患者。研究终点为总生存期（OS）、无进展生存期（PFS）和治疗反应率。

结果

HAIC-维持组和 Sorafenib-维持组的中位 OS 分别为 15.9 和 24.3 个月（p=0.287），中位 PFS 分别为 8.1 和 9.1 个月（p=0.651）。在计划治疗期间，HAIC-维持组和 Sorafenib-维持组的影像学客观缓解率（54.3% vs. 64.9%；p=0.246）和成功降期后手术切除或肝移植的转化率（15.9% vs. 18.9%；p=0.657）相似。经逆概率治疗加权和倾向评分匹配分析后也得到了相似的结果。关于治疗相关不良事件，HAIC-维持组在白细胞减少症（所有级别 [p=0.001] 和 3 或 4 级 [p=0.041]）和低白蛋白血症（p=0.001）方面的表现较 Sorafenib-维持组更差。