高危肝细胞癌：肝动脉灌注化疗与经动脉化疗栓塞术的比较
High-Risk Hepatocellular Carcinoma: Hepatic Arterial Infusion Chemotherapy versus Transarterial Chemoembolization.
作者信息
Zhang Baogen, Huang Biqing, Yang Fan, Yang Jiandong, Kong Man, Wang Jing, Xiang Yaoxian, Wang Kangjie, Peng Ruchen, Yang Kun, An Chao, Yan Dong
机构信息
Department of Oncology, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing, 101149, People's Republic of China.
Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, People's Republic of China.
出版信息
J Hepatocell Carcinoma. 2024 Mar 27;11:651-663. doi: 10.2147/JHC.S455953. eCollection 2024.
OBJECTIVE
To compare the efficacy and safety of hepatic arterial infusion chemotherapy (HAIC) with transarterial chemoembolization (TACE) for the treatment of high-risk hepatocellular carcinoma (hHCC) patients.
METHODS
Between January 2014 and August 2022, a total of 1765 consecutive patients with hHCC who underwent initial intra-arterial therapies were reviewed and divided into a TACE group (n, 507) and a HAIC group (n, 426). The study used propensity score matching (PSM) to reduce selectivity bias. Overall survival (OS) and progression-free survival (PFS) were compared using Kaplan‒Meier curves with the Log rank test. The objective response rate (ORR), conversion surgery rate (CSR) adverse event (AE) comparison and subgroup analysis were performed between the two groups.
RESULTS
After PSM 1:1, 444 patients were divided into two groups. The patients with hHCC who received HAIC had higher median PFS (6.1 vs 3.3 months, < 0.001) and OS (10.3 vs 8.2 months, =0.303) than TACE. Higher ORR (24.8% vs 11.7%) and CSR (15.5% vs 8.9%) were found in the HAIC group than in the TACE group (both < 0.05). The incidence of grade 3/4 AE was 23.9% and 8.1% in the TACE and HAIC groups, respectively. The subgroup analysis suggest that HAIC appeared to particularly benefit patients with tumor diameter of more than 10 centimeters (hazard ratio [HR], 0.6; 95% CI, 0.47-0.77; p, 0.00) and PVTT Vp4 (HR, 0.56; 95% CI, 0.39-0.8; , 0.01) for PFS outperforming TACE.
CONCLUSION
HAIC can provide better disease control for hHCC than cTACE, with a comparable long-term OS and safety.
目的
比较肝动脉灌注化疗（HAIC）与经动脉化疗栓塞术（TACE）治疗高危肝细胞癌（hHCC）患者的疗效和安全性。
方法
回顾2014年1月至2022年8月期间共1765例接受初始动脉内治疗的连续性hHCC患者，并将其分为TACE组（n = 507）和HAIC组（n = 426）。本研究采用倾向评分匹配（PSM）以减少选择性偏倚。使用Kaplan-Meier曲线和对数秩检验比较总生存期（OS）和无进展生存期（PFS）。对两组之间的客观缓解率（ORR）、转化手术率（CSR）、不良事件（AE）进行比较及亚组分析。
结果
经1:1 PSM后，444例患者被分为两组。接受HAIC治疗的hHCC患者的中位PFS（6.1个月对3.3个月，P < 0.001）和OS（10.3个月对8.2个月，P = 0.303）高于TACE组。HAIC组的ORR（24.8%对11.7%）和CSR（15.5%对8.9%）高于TACE组（均P < 0.05）。TACE组和HAIC组3/4级AE的发生率分别为23.9%和8.1%。亚组分析表明，对于PFS，HAIC似乎对肿瘤直径大于10厘米（风险比[HR]，0.6；95%置信区间[CI]，0.47 - 0.77；P，0.00）和门静脉癌栓Vp4（HR，0.56；95% CI，0.39 - 0.8；P，0.01）的患者特别有益，其表现优于TACE。
结论
与cTACE相比，HAIC可为hHCC提供更好的疾病控制，且长期OS和安全性相当。
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