Kim Gun Ha, Choi Sang Lim, Kim Jin Hyoung, Shim Ju Hyun, Alali Meshari, Kim Nayoung
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.
Life (Basel). 2021 Oct 10;11(10):1066. doi: 10.3390/life11101066.
The purpose of this study was to compare the efficacy and safety of transarterial chemoembolization (TACE) plus sorafenib with those of TACE alone in patients with locally advanced hepatocellular carcinoma (HCC). Treatment-naïve patients with preserved hepatic reserve (Child-Pugh score ≤ 7) who received TACE plus sorafenib ( = 91) or TACE alone ( = 109) for locally advanced HCC with macrovascular invasion were retrospectively evaluated. Propensity score matching (PSM) was used to correct selection bias, and 63 pairs were created. In the entire study population, the median progression-free survival (PFS) and overall survival (OS) with TACE plus sorafenib were better than those with TACE alone. After PSM, the median PFS (7.0 vs. 4.3 months; = 0.017) and OS (17.5 vs. 12.8 months; = 0.049) were again significantly longer with TACE plus sorafenib than with TACE alone. Stratified Cox regression analysis and doubly robust estimation revealed that treatment type was significantly associated with both PFS and OS. In the subgroup analysis, TACE plus sorafenib did not show a significant survival benefit for patients with main portal vein or inferior vena cava invasion. Major complications were similar in both groups ( = 0.330). In conclusion, TACE plus sorafenib showed better survival outcomes than TACE alone in patients with locally advanced HCC.
本研究的目的是比较经动脉化疗栓塞术（TACE）联合索拉非尼与单纯TACE治疗局部晚期肝细胞癌（HCC）患者的疗效和安全性。对初治且肝储备功能良好（Child-Pugh评分≤7）、因伴有大血管侵犯的局部晚期HCC接受TACE联合索拉非尼治疗（n = 91）或单纯TACE治疗（n = 109）的患者进行回顾性评估。采用倾向评分匹配（PSM）来校正选择偏倚，共生成63对。在整个研究人群中，TACE联合索拉非尼的中位无进展生存期（PFS）和总生存期（OS）均优于单纯TACE。PSM后，TACE联合索拉非尼的中位PFS（7.0 vs. 4.3个月；P = 0.017）和OS（17.5 vs. 12.8个月；P = 0.049）再次显著长于单纯TACE。分层Cox回归分析和双重稳健估计显示，治疗类型与PFS和OS均显著相关。在亚组分析中，TACE联合索拉非尼对伴有门静脉主干或下腔静脉侵犯的患者未显示出显著的生存获益。两组的主要并发症相似（P = 0.330）。总之，在局部晚期HCC患者中，TACE联合索拉非尼的生存结局优于单纯TACE。
