经导管动脉化疗栓塞联合阿帕替尼加 PD-1 抑制剂治疗合并门静脉癌栓的肝细胞癌：一项多中心回顾性研究。
Transarterial Chemoembolization Combined With Apatinib Plus PD-1 Inhibitors for Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: A Multicenter Retrospective Study.
机构信息
Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.
Department of Intervention, Henan Provincial People's Hospital, Zhengzhou, China.
出版信息
Clin Transl Gastroenterol. 2023 May 1;14(5):e00581. doi: 10.14309/ctg.0000000000000581.
INTRODUCTION
The aim of this study was to compare transarterial chemoembolization (TACE) combined with apatinib and PD-1 inhibitors (TACE-AP) with TACE combined with apatinib alone (TACE-A) in the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) and to explore the prognostic factors affecting the survival of patients.
METHODS
This retrospective study analyzed data of patients with HCC with PVTT who were treated with TACE-AP or TACE-A between December 2018 and June 2021. The primary end points of the study were progression-free survival (PFS) and overall survival (OS), and the secondary end points were objective response rate (ORR) and adverse events (AEs). Propensity score matching (PSM) and stabilized inverse probability weighting (sIPTW) analyses were used to reduce patient selection bias, and Cox regression analysis was used to analyze prognostic factors affecting patient survival.
RESULTS
Sixty-nine and 40 patients were included in the TACE-A and TACE-AP groups, respectively. After PSM and IPTW analyses, the median PFS and median OS in the TACE-AP group were significantly higher than those in the TACE-A group (PFS: after PSM, 6.9 vs 4.0 months, P < 0.001, after IPTW, 6.5 vs 5.1 months, P < 0.001; OS: after PSM, 14.6 vs 8.5 months P < 0.001, after IPTW, 16.1 vs 10.5 months, P < 0.001). After PSM and IPTW analyses, the tumor ORR in the TACE-AP group was significantly higher than that in the TACE-A group (PSM, 53.6% vs 17.9%, P = 0.005; IPTW, 52.5% vs 28.6%, P = 0.013). All treatment-related AEs were observed to be tolerated. Multivariate Cox regression analysis showed that the main prognostic factors affecting the survival of patients were tumor number, PVTT type, alpha-fetoprotein, and treatment mode.
DISCUSSION
In the treatment of patients with HCC with PVTT, TACE-AP significantly improved PFS, OS, and ORR, and the AEs were safe and controllable.
介绍
本研究旨在比较经动脉化疗栓塞术（TACE）联合阿帕替尼和 PD-1 抑制剂（TACE-AP）与 TACE 联合阿帕替尼单独治疗（TACE-A）治疗伴有门静脉癌栓（PVTT）的肝细胞癌（HCC）的疗效，并探讨影响患者生存的预后因素。
方法
本回顾性研究分析了 2018 年 12 月至 2021 年 6 月期间接受 TACE-AP 或 TACE-A 治疗的伴有 PVTT 的 HCC 患者的数据。主要终点为无进展生存期（PFS）和总生存期（OS），次要终点为客观缓解率（ORR）和不良事件（AEs）。采用倾向评分匹配（PSM）和稳定逆概率加权（sIPTW）分析以减少患者选择偏倚，采用 Cox 回归分析影响患者生存的预后因素。
结果
TACE-A 组和 TACE-AP 组分别纳入 69 例和 40 例患者。经 PSM 和 sIPTW 分析后，TACE-AP 组的中位 PFS 和中位 OS 明显长于 TACE-A 组（PFS：PSM 后，6.9 个月比 4.0 个月，P<0.001，sIPTW 后，6.5 个月比 5.1 个月，P<0.001；OS：PSM 后，14.6 个月比 8.5 个月，P<0.001，sIPTW 后，16.1 个月比 10.5 个月，P<0.001）。PSM 和 sIPTW 分析后，TACE-AP 组的肿瘤 ORR 明显高于 TACE-A 组（PSM，53.6%比 17.9%，P=0.005；sIPTW，52.5%比 28.6%，P=0.013）。所有治疗相关 AEs 均耐受良好。多因素 Cox 回归分析显示，影响患者生存的主要预后因素是肿瘤数量、PVTT 类型、甲胎蛋白和治疗方式。
讨论
在伴有 PVTT 的 HCC 患者的治疗中，TACE-AP 可显著改善 PFS、OS 和 ORR，且 AEs 安全可控。
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