经动脉化疗栓塞联合分子靶向药物加免疫检查点抑制剂治疗不可切除肝细胞癌：一项回顾性队列研究。
Transarterial chemoembolization combined with molecularly targeted agents plus immune checkpoint inhibitors for unresectable hepatocellular carcinoma: a retrospective cohort study.
机构信息
Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
出版信息
Front Immunol. 2023 Jul 31;14:1205636. doi: 10.3389/fimmu.2023.1205636. eCollection 2023.
PURPOSE
To retrospectively evaluate and compare treatment effectiveness and safety between transarterial chemoembolization (TACE) combined with molecularly targeted agents plus immune checkpoint inhibitors (TACE+T+I) and TACE combined with molecularly targeted agents (TACE+T) for unresectable hepatocellular carcinoma (uHCC).
METHODS
We retrospectively analyzed the data of patients with unresectable HCC from January 2018 to June 2022. The patients were screened based on the inclusion criteria and were divided into the triple combination group (TACE+T+I) and the double combination group (TACE+T). The primary outcomes were overall survival (OS), progression-free survival (PFS), and adverse events (AEs). The secondary outcomes were objective response rate (ORR) and disease control rate (DCR). Risk factors associated with PFS and OS were determined by Cox regression analysis.
RESULTS
A total of 87 patients were enrolled in this study, including 42 patients in the TACE+T+I group and 45 patients in the TACE+T group. Over a median follow-up of 29.00 and 26.70 months, patients who received TACE+T+I therapy achieved a significantly longer median OS (24.00 21.40 months, = 0.007) and median PFS (9.70 7.00 months, = 0.017); no grade 4 AEs or treatment-related death occurred in the two groups. Grade 3 AEs attributed to systemic agents in the two groups showed no significant difference (19.0% 15.6%, = 0.667). Patients in the TACE+T+I group demonstrated better tumor response when compared with patients in the TACE+T group, with an ORR of 52.4% 17.8% ( = 0.001). No significant difference was observed in DCR between the two groups (83.3% 77.8%, = 0.514. Cox regression analysis showed that only the treatment method was an independent factor of OS, and both age and treatment method were independent factors related to PFS.
CONCLUSION
Compared with TACE plus molecularly targeted agents (TACE+T), the triple therapy (TACE+T+I) could improve survival and tumor response in unresectable HCC with manageable toxicities.
目的
回顾性评估和比较不可切除肝细胞癌（uHCC）患者经动脉化疗栓塞术（TACE）联合分子靶向药物加免疫检查点抑制剂（TACE+T+I）与 TACE 联合分子靶向药物（TACE+T）治疗的有效性和安全性。
方法
我们回顾性分析了 2018 年 1 月至 2022 年 6 月间不可切除 HCC 患者的数据。根据纳入标准筛选患者，并分为三联治疗组（TACE+T+I）和双联治疗组（TACE+T）。主要终点是总生存期（OS）、无进展生存期（PFS）和不良事件（AEs）。次要终点是客观缓解率（ORR）和疾病控制率（DCR）。采用 Cox 回归分析确定与 PFS 和 OS 相关的危险因素。
结果
本研究共纳入 87 例患者，其中 TACE+T+I 组 42 例，TACE+T 组 45 例。中位随访 29.00 和 26.70 个月后，接受 TACE+T+I 治疗的患者 OS（24.00 21.40 个月， = 0.007）和 PFS（9.70 7.00 个月， = 0.017）显著延长；两组均未发生 4 级 AEs 或治疗相关死亡。两组中与全身药物相关的 3 级 AEs 无显著差异（19.0% 15.6%， = 0.667）。与 TACE+T 组相比，TACE+T+I 组患者肿瘤反应更好，ORR 为 52.4% 17.8%（ = 0.001）。两组 DCR 无显著差异（83.3% 77.8%， = 0.514）。Cox 回归分析表明，只有治疗方法是 OS 的独立因素，年龄和治疗方法是 PFS 的独立相关因素。
结论
与 TACE 联合分子靶向药物（TACE+T）相比，三联疗法（TACE+T+I）可提高不可切除 HCC 的生存率和肿瘤反应，且毒性可管理。
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