State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651# East Dongfeng Road, Guangzhou, 510060, People's Republic of China.
Department of Liver Surgery, Sun Yat-Sen University Cancer Center, 651# East Dongfeng Road, Guangzhou, 510060, People's Republic of China.
J Cancer Res Clin Oncol. 2023 Nov;149(16):14761-14774. doi: 10.1007/s00432-023-05243-7. Epub 2023 Aug 17.
Recently, the conversion therapies of FOLFOX-HAIC for patients with unresectable hepatocellular carcinoma (uHCC) have dramatically increased the tumor responses and conversion rate; thus, the prognosis of uHCC patients was expected to be prolonged. However, the postoperative recurrence of uHCC patients who successfully underwent conversion therapies stayed high. The present study evaluated the efficacy and safety of postoperatively adjuvant therapy in treating uHCC patients who received FOLFOX-HAIC-based conversion therapy.
In this real-world retrospective study, uHCC patients who received FOLFOX-HAIC-based conversion therapy were included. The recurrence-free survival (RFS), as primary outcomes, was compared between patients who received adjuvant therapy (AT group) or non-adjuvant therapy (nAT group) using survival analysis and Cox regression. Imbalances in baseline clinical features between the two groups were adjusted through propensity score matching (PSM) and inverse probability of treatment weighting (IPTW).
Between January 2016 and December 2022, 204 uHCC patients who received FOLFOX-HAIC-based conversion therapy were included and assigned into AT group (n = 47) and nAT group (n = 157), respectively. The median RFS was significantly longer in the AT group than the nAT group before adjustment [19.2 vs. 10.8 months; hazard ratio (HR), 0.584; 95% CI, 0.383-0.892; P = 0.028], after PSM and after IPTW. Subsequent subgroup analyses revealed the RFS of adjuvant therapy was best in uHCC patients with younger than 60 years, macrovascular invasion, and positive hepatitis B surface antigen.
Postoperatively, adjuvant therapy was associated with improved survival outcomes compared with non-adjuvant therapy after FOLFOX-HAIC-based conversion therapy among uHCC patients, especially for patients with macrovascular invasion and positive hepatitis B surface antigen.
最近，FOLFOX-HAIC 转化疗法显著提高了不可切除肝细胞癌（uHCC）患者的肿瘤反应率和转化率，从而延长了 uHCC 患者的预后。然而，接受成功转化治疗的 uHCC 患者术后复发率仍然很高。本研究评估了 FOLFOX-HAIC 转化治疗后辅助治疗治疗接受 FOLFOX-HAIC 转化治疗的 uHCC 患者的疗效和安全性。
本回顾性真实世界研究纳入接受 FOLFOX-HAIC 转化治疗的 uHCC 患者。采用生存分析和 Cox 回归比较接受辅助治疗（AT 组）和未接受辅助治疗（nAT 组）患者的无复发生存期（RFS）作为主要结局。通过倾向评分匹配（PSM）和逆概率处理权重（IPTW）调整两组间基线临床特征的不平衡。
2016 年 1 月至 2022 年 12 月，共纳入 204 例接受 FOLFOX-HAIC 转化治疗的 uHCC 患者，分别分为 AT 组（n=47）和 nAT 组（n=157）。在未调整时，AT 组的中位 RFS 明显长于 nAT 组[19.2 个月比 10.8 个月；风险比（HR），0.584；95%置信区间，0.383-0.892；P=0.028]，PSM 后和 IPTW 后也如此。随后的亚组分析显示，辅助治疗在年龄小于 60 岁、大血管侵犯和乙型肝炎表面抗原阳性的 uHCC 患者中 RFS 最佳。
与 FOLFOX-HAIC 转化治疗后未接受辅助治疗相比，uHCC 患者接受 FOLFOX-HAIC 转化治疗后接受辅助治疗可显著改善生存结局，尤其是对于大血管侵犯和乙型肝炎表面抗原阳性的患者。
