Hepato-Gastroenterology Department, CHU Amiens, Amiens.
CHU Bobigny, APHP, Liver Unit, Bobigny; Université Sorbonne Paris Nord, F-93000 Bobigny; Inserm, UMR-1138, Université de Paris, Paris.
Eur J Gastroenterol Hepatol. 2023 Oct 1;35(10):1168-1177. doi: 10.1097/MEG.0000000000002546. Epub 2023 Aug 11.
Hepatocellular carcinoma epidemiological data are limited in France. The Epidemio Liver Immunotherapy Tecentriq outcome research (ELITor) retrospective study, based on real-world data from the Carcinome HépatocellulaIrE en France (CHIEF) French cohort of hepatocellular carcinoma patients, aimed to get insight into the treatment patterns, the sociodemographic, clinical, biological, and etiological characteristics, and the quality of life of patients with unresectable hepatocellular carcinoma.
Between 1 September 2019 and 4 December 2020, 367 patients from the CHIEF cohort received at least one locoregional (52.8%) chemoembolization or radioembolization or systemic treatment (88.3%) and were selected for ELITor. Most patients had a Barcelona Clinic Liver Cancer (BCLC) C (93.2%) hepatocellular carcinoma stage and were affected by cirrhosis (67.7%). Alcohol was confirmed as the main etiology both as a single etiology (29.1%) and in association with other risk factors (26.9%), mainly metabolic disorders (16.2%).Tyrosine-kinase inhibitors, mainly sorafenib, were the most administered systemic treatments in first line. Patients who received at least one combination of atezolizumab and bevacizumab during the study period ( N = 53) had a better performance status and less portal hypertension frequency than the overall population and more hepatitis B virus infection and fewer metabolic disorders as single etiology. Overall, the global health score before treatment (62.3 ± 21.9) was in line with that of reference cancer patients and worsened in 51.9% of the cases after first-line palliative-intent treatment.
This study provided real-life data on advanced hepatocellular carcinoma characteristics and treatment patterns and described the first patients to receive the atezolizumab-bevacizumab combination before it became the new standard of care for advanced hepatocellular carcinoma.
法国的肝细胞癌流行病学数据有限。基于法国肝细胞癌患者的 Carcinome HépatocellulaIrE en France（CHIEF）队列的真实世界数据，Epidemio Liver Immunotherapy Tecentriq outcome research（ELITor）回顾性研究旨在深入了解不可切除肝细胞癌患者的治疗模式、社会人口学、临床、生物学和病因特征以及生活质量。
在 2019 年 9 月 1 日至 2020 年 12 月 4 日期间，从 CHIEF 队列中选择了 367 名至少接受过局部区域（52.8%）化疗栓塞或放射栓塞或全身治疗（88.3%）的患者入组 ELITor。大多数患者为巴塞罗那临床肝癌（BCLC）C 期肝细胞癌（93.2%）且患有肝硬化（67.7%）。酒精被证实为主要病因，无论是单一病因（29.1%）还是与其他危险因素相关（26.9%），主要是代谢紊乱（16.2%）。一线治疗中最常使用的系统治疗药物是酪氨酸激酶抑制剂，主要是索拉非尼。在研究期间接受至少一种阿替利珠单抗联合贝伐珠单抗治疗的患者（N=53）的表现状态优于总体人群，且更少发生门静脉高压，更多患有乙型肝炎病毒感染，更少患有单一病因的代谢紊乱。总体而言，治疗前的总体健康评分（62.3±21.9）与参考癌症患者相当，一线姑息治疗后 51.9%的患者评分恶化。
本研究提供了晚期肝细胞癌特征和治疗模式的真实数据，并描述了第一批接受阿替利珠单抗-贝伐珠单抗联合治疗的患者，该联合治疗成为晚期肝细胞癌的新标准治疗方案。
