Department of Interventional Radiology, Third Affiliated Hospital of Soochow University & Changzhou First People's Hospital, Juqian street NO.185, Tianning district, Changzhou, Jiangsu, 213003, China.
Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou & Changzhou First People's Hospital, Juqian street NO.185, Tianning district, Changzhou, Jiangsu, 213003, China.
Br J Radiol. 2024 Feb 28;97(1155):668-679. doi: 10.1093/bjr/tqae018.
To establish and verify a prognostic nomogram model for selecting in unresectable hepatocellular carcinoma (uHCC) treated by transarterial chemoembolization plus lenvatinib (TACE-L) with or without PD-1 inhibitor.
Data of 241 uHCC patients who underwent TACE-L (n = 128) and TACE-L plus PD-1 inhibitor (TACE-L-P, n = 113) were retrospectively reviewed. The differences in tumour responses, progression-free survival (PFS), overall survival (OS), and adverse events (AEs) between two groups were compared, and a prognostic nomogram model was established based on independent clinical-radiologic factors and confirmed by Cox regression analysis for predicting PFS and OS. The treatment selection for uHCC patients was stratified by the nomogram score.
Compared to TACE-L, TACE-L-P presented prolonged PFS (14.0 vs. 9.0 months, P < .001), longer OS (24.0 vs. 15.0 months, P < .001), and a better overall objective response rate (54.0% vs. 32.8%, P = .001). There was no significant difference between the rate of AEs in the TACE-L-P and the TACE-L (56.64% vs. 46.09%, P = .102) and the rate of grade ≥ 3 AEs (11.50% vs. 9.38%, P = .588), respectively. The nomogram model presented good discrimination, with a C-index of 0.790 for predicting PFS and 0.749 for predicting OS. Patients who underwent TACE-L and obtained a nomogram score >9 demonstrated improved 2-year PFS when transferred to TACE-L-P, and those with a nomogram ≤25 had better 2-year OS when transferred to TACE-L-P.
TACE-L-P showed significant improvements in efficiency and safety for uHCC patients compared with TACE-L. The nomogram was useful for stratifying treatment decisions and selecting a suitable population for uHCC patients.
Prognostic nomogram model is of great value in predicting individualized survival benefits for uHCC patients after TACE-L or/and TACE-L-P. And the nomogram was helpful for selection between TACE-L-P and TACE-L among uHCC patients.
建立并验证一个用于选择接受经动脉化疗栓塞联合仑伐替尼（TACE-L）治疗的不可切除肝细胞癌（uHCC）患者的预后列线图模型，这些患者联合或不联合 PD-1 抑制剂治疗。
回顾性分析了 241 例接受 TACE-L（n=128）和 TACE-L 联合 PD-1 抑制剂（TACE-L-P，n=113）治疗的 uHCC 患者的数据。比较两组患者的肿瘤反应、无进展生存期（PFS）、总生存期（OS）和不良事件（AE）差异，并基于独立的临床影像学因素建立预后列线图模型，通过 Cox 回归分析进行验证，以预测 PFS 和 OS。根据列线图评分对 uHCC 患者的治疗选择进行分层。
与 TACE-L 相比，TACE-L-P 组患者的 PFS 更长（14.0 个月比 9.0 个月，P<0.001），OS 更长（24.0 个月比 15.0 个月，P<0.001），总客观缓解率更高（54.0%比 32.8%，P=0.001）。TACE-L-P 组和 TACE-L 组的 AE 发生率（56.64%比 46.09%，P=0.102）和≥3 级 AE 发生率（11.50%比 9.38%，P=0.588）无显著差异。列线图模型具有良好的区分度，预测 PFS 的 C 指数为 0.790，预测 OS 的 C 指数为 0.749。在接受 TACE-L 治疗且列线图评分>9 的患者中，转为 TACE-L-P 治疗可提高 2 年 PFS，而在列线图评分≤25 的患者中，转为 TACE-L-P 治疗可提高 2 年 OS。
与 TACE-L 相比，TACE-L-P 可显著提高 uHCC 患者的疗效和安全性。该列线图模型可用于分层治疗决策，并为 uHCC 患者选择合适的人群。
预后列线图模型对于预测接受 TACE-L 或/和 TACE-L-P 治疗后的 uHCC 患者的个体化生存获益具有重要价值。并且该列线图有助于在 uHCC 患者中选择 TACE-L-P 与 TACE-L 之间的治疗方案。
