氟尿嘧啶、亚叶酸钙和奥沙利铂肝动脉灌注化疗与经动脉化疗栓塞作为局部进展期肝细胞癌初始治疗的比较：倾向评分匹配分析。
Hepatic Artery Infusion Chemotherapy Using Fluorouracil, Leucovorin, and Oxaliplatin versus Transarterial Chemoembolization as Initial Treatment for Locally Advanced Hepatocellular Carcinoma: A Propensity Score-Matching Analysis.
机构信息
Department of Experimental Research, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.
Department of Minimally Invasive Interventional Radiology, Center of Medical Imaging and Interventional Radiology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.
出版信息
J Vasc Interv Radiol. 2021 Sep;32(9):1267-1276.e1. doi: 10.1016/j.jvir.2021.06.008. Epub 2021 Jun 22.
PURPOSE
To compare the efficacy and safety of hepatic arterial infusion chemotherapy (HAIC) with a modified fluorouracil, leucovorin, and oxaliplatin (mFOLFOX) regimen with that of transarterial chemoembolization as a locoregional treatment for patients with locally advanced hepatocellular carcinoma (HCC).
METHODS
This retrospective study included adult patients with locally advanced HCC who received first-line treatment with either HAIC-mFOLFOX or conventional transarterial chemoembolization monotherapy from January 2015 to December 2016. The outcomes, including tumor response rates, evaluated via imaging assessment using the modified response evaluation criteria in solid tumors; overall survival; progression-free survival; and safety, were compared. The propensity score-matching methodology was used to reduce the influence of confounding factors on the outcomes.
RESULTS
The study included 131 patients with locally advanced HCC who underwent transarterial chemoembolization and 101 who received HAIC-mFOLFOX as initial treatment. After propensity score matching (n = 67 in each group), patients who received HAIC-mFOLFOX had a higher objective response rate (43.3% vs 13.4%, P = .001), longer median overall survival (13.9 vs 6.0 months, P < .001), and longer median progression-free survival (6.4 vs 2.8 months, P = .001) than those who underwent transarterial chemoembolization. The survival benefit with HAIC-mFOLFOX was strengthened in patients with HCC with vascular invasion (hazard ratio: 0.379; 95% confidence interval: 0.237-0.607). HAIC-mFOLFOX was associated with lower incidences of severe adverse events (8.9% vs 22.9%) and liver toxicity than transarterial chemoembolization.
CONCLUSIONS
Compared with transarterial chemoembolization, HAIC-mFOLFOX is a potentially safer and more effective locoregional therapy for patients with locally advanced HCC.
目的
比较肝动脉灌注化疗（HAIC）联合改良氟尿嘧啶、亚叶酸钙和奥沙利铂（mFOLFOX）方案与传统经动脉化疗栓塞（TACE）作为局部晚期肝细胞癌（HCC）局部区域治疗的疗效和安全性。
方法
本回顾性研究纳入了 2015 年 1 月至 2016 年 12 月期间接受一线治疗的局部晚期 HCC 成年患者，治疗方案分别为 HAIC-mFOLFOX 或常规 TACE 单药治疗。比较两组的疗效，包括使用实体瘤改良疗效评价标准评估的肿瘤反应率、总生存期、无进展生存期和安全性。采用倾向评分匹配方法以减少混杂因素对结局的影响。
结果
本研究纳入了 131 例接受 TACE 治疗的局部晚期 HCC 患者和 101 例接受 HAIC-mFOLFOX 作为初始治疗的患者。经过倾向评分匹配（每组 n=67）后，接受 HAIC-mFOLFOX 治疗的患者客观缓解率（43.3% vs 13.4%，P=0.001）更高，中位总生存期（13.9 个月 vs 6.0 个月，P<0.001）和中位无进展生存期（6.4 个月 vs 2.8 个月，P=0.001）更长。在有血管侵犯的 HCC 患者中，HAIC-mFOLFOX 的生存获益更强（风险比：0.379；95%置信区间：0.237-0.607）。HAIC-mFOLFOX 与 TACE 相比，严重不良事件（8.9% vs 22.9%）和肝毒性发生率更低。
结论
与 TACE 相比，HAIC-mFOLFOX 是局部晚期 HCC 患者一种更安全、更有效的局部区域治疗方法。
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