Xiang Yan-Jun, Wang Kang, Zheng Yi-Tao, Feng Shuang, Yu Hong-Ming, Li Xiao-Wei, Cheng Xi, Cheng Yu-Qiang, Feng Jin-Kai, Zhou Li-Ping, Meng Yan, Zhai Jian, Shan Yun-Feng, Cheng Shu-Qun
Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.
Department of Hepatobiliary Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
Front Oncol. 2022 Mar 21;12:839605. doi: 10.3389/fonc.2022.839605. eCollection 2022.
Patients with intermediate-stage hepatocellular carcinoma (HCC) who are refractory to transarterial chemoembolization (TACE) have a poor prognosis. This study aimed to explore whether stereotactic body radiation therapy (SBRT) combined with PD-1 inhibitors could improve the clinical outcomes of such patients.
This retrospective cohort study included patients with intermediate-stage HCC who were diagnosed with TACE refractoriness between January 2019 and December 2020 in the Eastern Hepatobiliary Surgery Hospital and the First Affiliated Hospital of Wenzhou Medical University. The patients were divided into two groups: (1) those who switched from TACE to receive stereotactic body radiotherapy (SBRT) combined with PD-1 inhibitors; (2) those who continued TACE treatment and added PD-1 inhibitors. Progression-free survival (PFS), overall survival (OS), and tumour response were assessed in both groups after becoming refractory to TACE treatment.
Of the seventy-six patients included in this study, the median PFS was 19.6 months in the SBRT-IO group (n=31) and 10.1 months in the TACE-IO group (n=45, p<0.05). The SBRT-IO group also had a significantly higher OS than the TACE-IO group (p<0.05). The objective response rate (ORR) and disease control rate (DCR) were also better in the SBRT-IO group (ORR, 71.0% vs. 15.6%, OR=8.483, 95% CI 3.319-21.680, P < 0.001; DCR, 80.6% vs. 31.1%, OR=9.226, 95% CI 3.096-27.493, P < 0.001).
SBRT combined with a PD-1 inhibitor improves PFS and OS in TACE-refractory patients with intermediate-stage HCC. Therefore, this therapy is a suitable option in cases of TACE treatment failure.
对经动脉化疗栓塞术（TACE）难治的中期肝细胞癌（HCC）患者预后较差。本研究旨在探讨立体定向体部放射治疗（SBRT）联合PD-1抑制剂是否能改善此类患者的临床结局。
本回顾性队列研究纳入了2019年1月至2020年12月期间在东方肝胆外科医院和温州医科大学附属第一医院被诊断为难治性TACE的中期HCC患者。患者分为两组：（1）从TACE转换为接受立体定向体部放射治疗（SBRT）联合PD-1抑制剂的患者；（2）继续TACE治疗并加用PD-1抑制剂的患者。在对TACE治疗难治后，评估两组患者的无进展生存期（PFS）、总生存期（OS）和肿瘤反应。
本研究纳入的76例患者中，SBRT-IO组（n=31）的中位PFS为19.6个月，TACE-IO组（n=45，p<0.05）为10.1个月。SBRT-IO组的OS也显著高于TACE-IO组（p<0.05）。SBRT-IO组的客观缓解率（ORR）和疾病控制率（DCR）也更好（ORR，71.0%对15.6%，OR=8.483，95%CI 3.319-21.680，P<0.001；DCR，80.6%对31.1%，OR=9.226，95%CI 3.096-27.493，P<0.001）。
SBRT联合PD-1抑制剂可改善TACE难治的中期HCC患者的PFS和OS。因此，在TACE治疗失败的情况下，这种治疗是一种合适的选择。
