Zhang Zeyu, Li Chan, Liao Weijun, Huang Yun, Wang Zhiming
Department of Hepatobiliary Surgery, Xiangya Hospital, Central South University, Changsha 410078, China.
Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha 410078, China.
Cancers (Basel). 2022 Jul 25;14(15):3619. doi: 10.3390/cancers14153619.
Background: This study compared the effectiveness of the combined administration of sorafenib, an immune checkpoint inhibitor, transcatheter arterial chemoembolization (TACE), and stereotactic body radiation therapy (SBRT) (SITS group) vs. sorafenib combined with TACE (ST group) in treating and downstaging advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Methods: The present study included patients with advanced HCC and PVTT treated with one of the above combination therapies. The downstaging rate, objective response rate (ORR), progression-free survival (PFS), overall survival (OS), disease control rate (DCR), and adverse events (AEs) were assessed. Results: Sixty-two patients were analyzed. The ORR was elevated in the SITS group compared with the ST group (p = 0.036), but no differences were found in DCR (p = 0.067). The survival analysis revealed higher PFS (p = 0.015) and OS (p = 0.013) in the SITS group, with median PFS and OS times of 10.4 and 13.8 months, respectively. Ten patients displayed successful downstaging and underwent surgery in the SITS group, vs. none in the ST group. The prognosis was better in surgically treated patients compared with the non-surgery subgroup, based on PFS (p < 0.001) and OS (p = 0.003). Despite a markedly higher rate of AEs in the SITS group (p = 0.020), including two severe AEs, the SITS combination therapy had an acceptable safety profile. Conclusion: The SITS combination therapy yields higher PFS and OS than the combined administration of sorafenib and TACE in patients with advanced HCC and PVTT, especially as a downstaging strategy before surgery.
本研究比较了索拉非尼、免疫检查点抑制剂、经动脉化疗栓塞术（TACE）和立体定向体部放射治疗（SBRT）联合应用（SITS组）与索拉非尼联合TACE（ST组）在治疗伴有门静脉癌栓（PVTT）的晚期肝细胞癌（HCC）并使其降期方面的有效性。方法：本研究纳入了接受上述联合治疗之一的晚期HCC和PVTT患者。评估降期率、客观缓解率（ORR）、无进展生存期（PFS）、总生存期（OS）、疾病控制率（DCR）和不良事件（AE）。结果：分析了62例患者。与ST组相比，SITS组的ORR有所提高（p = 0.036），但DCR无差异（p = 0.067）。生存分析显示SITS组的PFS（p = 0.015）和OS（p = 0.013）更高，中位PFS和OS时间分别为10.4个月和13.8个月。SITS组有10例患者成功降期并接受了手术，而ST组无一例。基于PFS（p < 0.001）和OS（p = 0.003），手术治疗患者的预后优于未手术亚组。尽管SITS组的AE发生率明显更高（p = 0.020），包括2例严重AE，但SITS联合治疗的安全性可接受。结论：对于伴有PVTT的晚期HCC患者，SITS联合治疗比索拉非尼与TACE联合应用能产生更高PFS和OS，尤其是作为手术前的降期策略。
