酪氨酸激酶抑制剂联合碘-125 放射性粒子近距离放疗治疗经肝动脉化疗栓塞治疗后复发的肝细胞癌: 一项倾向性匹配研究。
Tyrosine-kinase inhibitor combined with iodine-125 seed brachytherapy for hepatocellular carcinoma refractory to transarterial chemoembolization: a propensity-matched study.
机构信息
Department of Minimally Invasive Interventional Radiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
Radiology Center, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
出版信息
Cancer Imaging. 2023 Sep 25;23(1):91. doi: 10.1186/s40644-023-00604-4.
PURPOSE
To investigate the efficacy and safety of tyrosine-kinase inhibitor (TKI) combined with iodine-125 seed brachytherapy (TKI-I) versus TKI alone for patients with hepatocellular carcinoma (HCC) refractory to transarterial chemoembolization (TACE).
METHODS
Data of patients with TACE-refractory HCC who received TKI (sorafenib or lenvatinib) or TKI-I from September 2018 to December 2020 were retrospectively analyzed. A propensity score matching (PSM) was performed to diminish potential bias. The primary endpoints were overall survival (OS) and time to progression (TTP). Tumor responses and treatment-related adverse events (TRAEs) were also compared between the two groups.
RESULTS
A total of 132 patients were included in this study. Under PSM, 48 paired patients were selected for comparison. The median OS was 23.2 (95% CI 20.9-25.1) months in the TKI-I group versus 13.9 (95% CI 11.1-16.7) months in the TKI group (P < 0.001). The median TTP was 12.8 (95% CI 10.1-15.5) months in the TKI-I group versus 5.8 (95% CI 5.0-6.6) months in the TKI group (P < 0.001). Patients in the TKI-I group had higher objective response rate (68.8% vs. 33.3%, P = 0.001) and disease control rate (89.6% vs. 66.7%, P = 0.007) than those in the TKI group. The incidence and severity of TRAEs in the TKI-I group were comparable to those in the TKI group (any grade, 89.7% vs. 92.2%, P = 0.620; ≥grade 3, 33.8% vs. 32.8%, P = 0.902).
CONCLUSIONS
TKI-I was safe and significantly improved survival over TKI alone in HCC patients with TACE refractoriness.
目的
探讨酪氨酸激酶抑制剂（TKI）联合碘-125 放射性粒子近距离放疗（TKI-I）与单独 TKI 治疗经动脉化疗栓塞（TACE）耐药的肝细胞癌（HCC）患者的疗效和安全性。
方法
回顾性分析 2018 年 9 月至 2020 年 12 月接受 TKI（索拉非尼或仑伐替尼）或 TKI-I 治疗的 TACE 耐药 HCC 患者的数据。采用倾向评分匹配（PSM）消除潜在偏倚。主要终点为总生存期（OS）和无进展生存期（TTP）。比较两组患者的肿瘤反应和治疗相关不良反应（TRAEs）。
结果
本研究共纳入 132 例患者。经 PSM 后，选择了 48 对配对患者进行比较。TKI-I 组的中位 OS 为 23.2（95%CI 20.9-25.1）个月，TKI 组为 13.9（95%CI 11.1-16.7）个月（P<0.001）。TKI-I 组的中位 TTP 为 12.8（95%CI 10.1-15.5）个月，TKI 组为 5.8（95%CI 5.0-6.6）个月（P<0.001）。TKI-I 组的客观缓解率（68.8% vs. 33.3%，P=0.001）和疾病控制率（89.6% vs. 66.7%，P=0.007）均高于 TKI 组。TKI-I 组 TRAEs 的发生率和严重程度与 TKI 组相当（任何级别，89.7% vs. 92.2%，P=0.620；≥3 级，33.8% vs. 32.8%，P=0.902）。
结论
TKI-I 联合 TACE 耐药 HCC 患者的 TKI 治疗安全且显著改善了患者的生存。
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