基于 TKI 联合 PD-1 抑制剂治疗不可切除复发性肝细胞癌的疗效。

Efficacy of treatment based on TKIs in combination with PD-1 inhibitors for unresectable recurrent hepatocellular carcinoma.

机构信息

Medical School of Chinese People's Liberation Army (PLA), Beijing, China.

Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing, China.

出版信息

World J Surg Oncol. 2023 Feb 18;21(1):53. doi: 10.1186/s12957-023-02939-5.

BACKGROUND AND OBJECTIVE

The recurrence occurs within 5 years in up to 70% of hepatocellular carcinoma (HCC) patients who received radical liver resection, and most patients are no longer suitable for repeat surgery. There are limited treatment options for unresectable recurrent HCC. This study aimed to explore the potential efficacy of treatment based on TKIs in combination with PD-1 inhibitors for unresectable recurrent HCC.

METHODS

Forty-four patients with unresectable recurrent HCC after radical surgery between January 2017 and November 2022 were retrospectively collected and screened. All patients received the combination therapy of tyrosine kinase inhibitors (TKIs) and programmed cell death protein 1 (PD-1) inhibitors, and 18 of these patients received trans-arterial chemoembolization (TACE) or TACE combined with radiofrequency ablation (RFA). Two patients who received TKIs in combination with PD-1 inhibitors eventually obtained repeat surgery, with one patient undergoing a repeat hepatectomy and one patient receiving a liver transplant.

RESULTS

The median survival for these patients was 27.0 months (95% confidence interval [CI] 21.2, 32.8), with a 1-year overall survival (OS) rate of 83.6% (95% CI 77.9%, 89.3%). Median progression-free survival (PFS) was 15.0 months (95.0% CI 12.1, 17.9), with a 1-year PFS rate of 77.0% (95% CI 70.6%, 83.4%). The two patients who underwent repeat surgery had a survival time of 34 and 37 months after the combined treatment with no recurrence, respectively, as of November 2022.

CONCLUSION

The combination of TKIs and PD-1 inhibitors for unresectable recurrent HCC is effective and can prolong the survival of patients in this group.

背景与目的

接受根治性肝切除术的肝细胞癌（HCC）患者中，多达 70%的患者在 5 年内复发，且大多数患者不再适合重复手术。对于不可切除的复发性 HCC，治疗选择有限。本研究旨在探讨基于 TKI 联合 PD-1 抑制剂治疗不可切除复发性 HCC 的潜在疗效。

方法

回顾性收集并筛选了 2017 年 1 月至 2022 年 11 月期间根治性手术后出现不可切除复发性 HCC 的 44 例患者。所有患者均接受酪氨酸激酶抑制剂（TKI）联合程序性死亡蛋白 1（PD-1）抑制剂的联合治疗，其中 18 例患者接受了经动脉化疗栓塞（TACE）或 TACE 联合射频消融（RFA）治疗。2 例患者接受 TKI 联合 PD-1 抑制剂治疗后最终获得重复手术，其中 1 例患者接受了重复肝切除术，1 例患者接受了肝移植。

结果

这些患者的中位总生存期为 27.0 个月（95%置信区间[CI] 21.2, 32.8），1 年总生存率（OS）为 83.6%（95%CI 77.9%, 89.3%）。中位无进展生存期（PFS）为 15.0 个月（95.0%CI 12.1, 17.9），1 年 PFS 率为 77.0%（95%CI 70.6%, 83.4%）。截至 2022 年 11 月，接受联合治疗后进行重复手术的 2 例患者的生存时间分别为 34 个月和 37 个月，均无复发。