Lin Long-Wang, Yan Le-Ye, Ke Kun, Yang Wei-Zhu, Lin Jun-Qing, Huang Ning
Department of Interventional Radiology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
Department of Interventional Radiology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
Brachytherapy. 2023 Nov-Dec;22(6):858-871. doi: 10.1016/j.brachy.2023.06.229. Epub 2023 Aug 12.
Therapy for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) is still controversial. This study was performed to evaluate the efficacy and safety of the combination therapy comprising transarterial chemoembolization (TACE), lenvatinib (L), programmed death-1 inhibitor (P), and iodine-125 seed (I) brachytherapy relative to TACE in combination with lenvatinib plus programmed death-1 inhibitor therapy and TACE plus lenvatinib therapy.
The data of HCC patients with PVTT from July 2017 to August 2022 were assessed in this single-center retrospective study. Primary study outcomes were progression-free survival (PFS) and overall survival (OS), while the secondary outcomes were disease control rate (DCR), objective response rate (ORR), and treatment-related adverse events.
We enrolled 150 patients totally, including 50 patients treated with TACE plus lenvatinib therapy (TACE+L group), 45 patients treated with TACE in combination with lenvatinib plus programmed death-1 inhibitor therapy (TACE+L+P group), and 55 patients treated with the combination therapy of TACE along with I brachytherapy, lenvatinib, and programmed death-1 inhibitor therapy (TACE+L+P+I group). The median OS in the TACE+L+P+I group (21.0; 95% confidence interval [CI]: 18.4∼23.5 months) was significantly longer than that in the TACE+L group (10; 95% CI: 7.8∼12.1months) (p = 0.006), while it was insignificantly longer than that in the TACE+L+P group (14.0; 95% CI: 10.7∼17.2months) (p = 0.058). The median PFS in the TACE+L+P+I group (13.0; 95% CI: 10.2∼15.7 months) was significantly longer than that in the TACE+L group (5.0; 95% CI: 4.2∼5.7 months) (p = 0.014) and the TACE+L+P group (9.0; 95% CI: 6.7∼11.2 months) (p = 0.048). Statistically significant differences between groups were found in DCR (p = 0.015). There were no significant between-group differences in treatment-related adverse events (p > 0.05).
A combination therapy of TACE, lenvatinib, programmed death-1 inhibitor, and I seed brachytherapy significantly improve OS, PFS, and DCR and show better survival prognosis for HCC patients accompanied by PVTT.
肝细胞癌（HCC）伴门静脉癌栓（PVTT）患者的治疗仍存在争议。本研究旨在评估经动脉化疗栓塞术（TACE）、仑伐替尼（L）、程序性死亡-1抑制剂（P）和碘-125粒子（I）近距离放射治疗的联合疗法相对于TACE联合仑伐替尼加程序性死亡-1抑制剂疗法以及TACE加仑伐替尼疗法的疗效和安全性。
在这项单中心回顾性研究中，评估了2017年7月至2022年8月HCC伴PVTT患者的数据。主要研究结局为无进展生存期（PFS）和总生存期（OS），次要结局为疾病控制率（DCR）、客观缓解率（ORR）和治疗相关不良事件。
我们共纳入150例患者，其中50例接受TACE加仑伐替尼治疗（TACE+L组），45例接受TACE联合仑伐替尼加程序性死亡-1抑制剂治疗（TACE+L+P组），55例接受TACE联合I粒子近距离放射治疗、仑伐替尼和程序性死亡-1抑制剂治疗（TACE+L+P+I组）。TACE+L+P+I组的中位OS（21.0；95%置信区间[CI]：18.4～23.5个月）显著长于TACE+L组（10；95%CI：7.8～12.1个月）（p = 0.006），而略长于TACE+L+P组（14.0；95%CI：10.7～17.2个月）（p = 0.058）。TACE+L+P+I组的中位PFS（13.0；95%CI：10.2～15.7个月）显著长于TACE+L组（5.0；95%CI：4.2～5.7个月）（p = 0.014）和TACE+L+P组（9.0；95%CI：6.7～11.2个月）（p = 0.048）。组间DCR存在统计学显著差异（p = 0.015）。治疗相关不良事件在组间无显著差异（p>0.05）。
TACE、仑伐替尼、程序性死亡-1抑制剂和I粒子近距离放射治疗的联合疗法显著改善了OS、PFS和DCR，并为伴有PVTT的HCC患者显示出更好的生存预后。
