Ouyang Tao, Liu Junxia, Shi Chengyang, Zhu Lisheng, Guo Xiaopeng
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Cancer Medical Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China.
J Hepatocell Carcinoma. 2021 Nov 26;8:1459-1471. doi: 10.2147/JHC.S338309. eCollection 2021.
This study aims to compare the efficacy of drug-eluting bead transarterial chemoembolization (DEB-TACE) versus conventional TACE (cTACE), both combined with apatinib, and to establish predictive nomograms to support individualized survival prediction in hepatocellular carcinoma (HCC) patients.
This retrospective study assessed HCC patients from June 2015 to December 2019. Patients were classified as DEB-TACE plus apatinib (D-apatinib) and cTACE plus apatinib (c-apatinib). The endpoints were overall survival (OS) and progression-free survival (PFS). The nomograms were constructed, and the C-index, receiver operating characteristic (ROC) curve, and calibration curves were used to validate the nomograms. Propensity score matching (PSM) analysis was applied to reduce patient selection bias.
A total of 174 patients were included. After PSM analysis, 58 pairs of patients were selected. Before PSM analysis, the median OS and PFS were 21.0 and 8.0 months in the D-apatinib group, respectively, which were better than the 18.0 and 5.0 months observed in the c-apatinib group (P < 0.05). The complete response (CR) rate and objective response rate (ORR) of the D-apatinib group were higher than those of the c-apatinib group. The C-index values of the nomograms in the D-apatinib group and the c-apatinib group were 0.826 and 0.802, and the area under the curve (AUC) values in the ROC curve were 0.934 and 0.892. After PSM analysis, the survival of patients treated with D-apatinib was better than that of patients treated with c-apatinib (P < 0.05). The C-index values were 0.854 and 0.794 in the D-apatinib group and the c-apatinib group, respectively, and the AUC values were 0.960 and 0.890. The incidence of adverse events was higher in the c-apatinib group.
DEB-TACE in combination with apatinib showed better treatment effectiveness for unresectable HCC. The nomograms can identify HCC patients who may benefit most from the treatment.
本研究旨在比较载药微球经动脉化疗栓塞术（DEB-TACE）与传统经动脉化疗栓塞术（cTACE）联合阿帕替尼的疗效，并建立预测列线图以支持肝细胞癌（HCC）患者的个体化生存预测。
这项回顾性研究评估了2015年6月至2019年12月期间的HCC患者。患者被分为DEB-TACE联合阿帕替尼组（D-阿帕替尼组）和cTACE联合阿帕替尼组（c-阿帕替尼组）。终点指标为总生存期（OS）和无进展生存期（PFS）。构建列线图，并使用C指数、受试者工作特征（ROC）曲线和校准曲线来验证列线图。应用倾向评分匹配（PSM）分析以减少患者选择偏倚。
共纳入174例患者。经过PSM分析，选择了58对患者。在PSM分析前，D-阿帕替尼组的中位OS和PFS分别为21.0个月和8.0个月，优于c-阿帕替尼组观察到的18.0个月和5.0个月（P<0.05）。D-阿帕替尼组的完全缓解（CR）率和客观缓解率（ORR）高于c-阿帕替尼组。D-阿帕替尼组和c-阿帕替尼组列线图的C指数值分别为0.826和0.802，ROC曲线下面积（AUC）值分别为0.934和0.892。经过PSM分析，接受D-阿帕替尼治疗的患者的生存期优于接受c-阿帕替尼治疗的患者（P<0.05）。D-阿帕替尼组和c-阿帕替尼组的C指数值分别为0.854和0.794，AUC值分别为0.960和0.890。c-阿帕替尼组不良事件的发生率更高。
DEB-TACE联合阿帕替尼对不可切除的HCC显示出更好治疗效果。列线图可以识别可能从该治疗中获益最大的HCC患者。
