Department of Interventional Therapy, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), 52 Fucheng Road, Haidian District, Beijing 100142, China.
Biomed Res Int. 2021 Jul 14;2021:6670367. doi: 10.1155/2021/6670367. eCollection 2021.
Survival of patients with portal vein tumor thrombosis (PVTT) is extremely poor; transarterial chemoembolization (TACE) is a treatment for patients with HCC and PVTT. Some studies showed that hepatic arterial infusion chemotherapy (HAIC) might improve the survival of HCC with PVTT. There were few researches of combining TACE with HAIC for patients with HCC and PVTT.
This study was aimed at comparing overall survival (OS) and progression-free survival (PFS) following treatment with conventional transarterial chemoembolization plus hepatic arterial infusion chemotherapy (cTACE-HAIC) or conventional transarterial chemoembolization (cTACE) alone in patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT).
From January 2011 to December 2016, 155 patients with HCC and PVTT who received cTACE-HAIC (cTACE-HAIC group) ( = 86) or cTACE alone (cTACE group) ( = 69) were retrospectively evaluated. Propensity score matching (PSM) reduced the confounding bias and yielded 60 matched patient pairs. The tumors' responses were evaluated using the modified response evaluation criteria in solid tumors (mRECIST). OS and PFS of groups were compared using the Kaplan-Meier method, log-rank test, and Cox proportional hazard regression models.
The median follow-up duration was 93 months (range: 1-93 months). The cTACE-HAIC group's OS (9.0 months) and PFS (6.0 months) were significantly longer than the cTACE group's OS (5.0 months) and PFS (2.0 months) ( = 0.018 and = 0.045, respectively) in the matched cohort. Multivariate analyses showed that cTACE-HAIC was independently associated with OS (hazard ratio (HR) 0.602, = 0.010) and PFS (HR 0.66, = 0.038). The matched groups did not differ regarding grade 3 or 4 adverse events.
cTACE-HAIC was superior to cTACE alone regarding OS and PFS in patients with HCC and PVTT. Treatment-associated toxicities were generally well tolerated.
门静脉癌栓（PVTT）患者的生存预后极差；经肝动脉化疗栓塞术（TACE）是治疗肝细胞癌（HCC）合并 PVTT 的一种方法。一些研究表明，肝动脉灌注化疗（HAIC）可能改善合并 PVTT 的 HCC 患者的生存。对于 HCC 合并 PVTT 患者，TACE 联合 HAIC 的研究较少。
本研究旨在比较常规 TACE 联合 HAIC（cTACE-HAIC）与单纯常规 TACE（cTACE）治疗 HCC 合并 PVTT 患者的总生存期（OS）和无进展生存期（PFS）。
2011 年 1 月至 2016 年 12 月，155 例 HCC 合并 PVTT 患者接受 cTACE-HAIC（cTACE-HAIC 组）（n=86）或单纯 cTACE（cTACE 组）（n=69）治疗，采用倾向性评分匹配（PSM）法对患者进行 1∶1 匹配，共获得 60 对匹配患者。采用实体瘤疗效评价标准（mRECIST）评价肿瘤反应。采用 Kaplan-Meier 法、log-rank 检验和 Cox 比例风险回归模型比较两组的 OS 和 PFS。
中位随访时间为 93 个月（范围：1~93 个月）。匹配后，cTACE-HAIC 组的 OS（9.0 个月）和 PFS（6.0 个月）明显长于 cTACE 组的 OS（5.0 个月）和 PFS（2.0 个月）（P=0.018 和 P=0.045）。多因素分析显示，cTACE-HAIC 与 OS（风险比（HR）0.602，P=0.010）和 PFS（HR 0.66，P=0.038）独立相关。两组间 3 级或 4 级不良事件发生率无差异。
与单纯 cTACE 相比，cTACE-HAIC 可改善 HCC 合并 PVTT 患者的 OS 和 PFS，且治疗相关毒性可耐受。
