乐伐替尼联合载药微球经动脉化疗栓塞术联合或不联合肝动脉灌注化疗治疗直径大于7cm且伴有主要门静脉肿瘤血栓形成的肝细胞癌：一项多中心回顾性队列研究
Lenvatinib plus drug-eluting bead transarterial chemoembolization with/without hepatic arterial infusion chemotherapy for hepatocellular carcinoma larger than 7 cm with major portal vein tumor thrombosis: a multicenter retrospective cohort study.
作者信息
Cai Mingyue, Liang Licong, Zhang Jian, Chen Nianping, Huang Wensou, Guo Yongjian, Hong Xiaotao, Lin Liteng, Liu Yaohong, Dan Cao, Deng Haihui, Liu Xiaoguang, Zhou Jingwen, Chen Ye, Chen Huanwei, Zhu Kangshun
机构信息
Department of Minimally Invasive Interventional Radiology, The Second Affiliated Hospital of Guangzhou Medical University.
Department of Interventional Medicine, Zhongshan City People's Hospital, Zhongshan.
出版信息
Int J Surg. 2024 Dec 1;110(12):7860-7870. doi: 10.1097/JS9.0000000000001819.
BACKGROUND
The management of hepatocellular carcinoma (HCC) with high tumor burden and major portal vein tumor thrombosis (PVTT) remains a great challenge. The authors aimed to investigate the efficacy and safety of lenvatinib plus drug-eluting bead transarterial chemoembolization (DEB-TACE) and hepatic arterial infusion chemotherapy (HAIC) with oxaliplatin, fluorouracil and leucovorin (Len+DEB-TACE+HAIC) versus lenvatinib plus DEB-TACE (Len+DEB-TACE) for HCC greater than 7.0 cm accompanied with major PVTT.
MATERIALS AND METHODS
This multicenter retrospective cohort study evaluated consecutive patients with HCC (> 7.0 cm) and major PVTT who received Len+DEB-TACE+HAIC (Len+DEB-TACE+HAIC group) or Len+DEB-TACE (Len+DEB-TACE group) between July 2019 and June 2021 from eight institutions in China. Objective response rate (ORR), time to progression (TTP), overall survival (OS), and treatment-related adverse events (TRAEs) were compared between the two groups by propensity score matching (PSM).
RESULTS
A total of 205 patients were included. After PSM, 85-paired patients remained in the study cohorts. Patients in the Len+DEB-TACE+HAIC group had higher ORR (61.2% vs. 34.1%, P < 0.001), longer TTP (median, 9.8 vs. 5.9 months, P < 0.001), and prolonged OS (median, 16.7 vs. 12.5 months, P < 0.001) than those in the Len+DEB-TACE group. The ORR and TTP of both intrahepatic tumor (ORR: 64.7% vs. 36.5%, P < 0.001; median TTP: 10.7 vs. 7.0 months, P < 0.001) and PVTT (ORR: 74.1% vs. 47.1%, P < 0.001; median TTP: 17.4 vs. 7.6 months, P < 0.001) were better in the Len+DEB-TACE+HAIC group than the Len+DEB-TACE group. The frequency of grade 3-4 TRAEs in the Len+DEB-TACE+HAIC group were comparable to those in the Len+DEB-TACE group (38.8% vs. 34.1%, P = 0.524).
CONCLUSION
The addition of HAIC to Len+DEB-TACE significantly improved ORR, TTP, and OS over Len+DEB-TACE with an acceptable safety profile for large HCC with major PVTT.
背景
高肿瘤负荷和主要门静脉肿瘤血栓形成（PVTT）的肝细胞癌（HCC）的管理仍然是一个巨大挑战。作者旨在研究乐伐替尼联合载药微球经动脉化疗栓塞术（DEB-TACE）和奥沙利铂、氟尿嘧啶及亚叶酸钙的肝动脉灌注化疗（HAIC）（Len+DEB-TACE+HAIC）与乐伐替尼联合DEB-TACE（Len+DEB-TACE）治疗直径大于7.0 cm且伴有主要PVTT的HCC的疗效和安全性。
材料与方法
这项多中心回顾性队列研究评估了2019年7月至2021年6月期间来自中国8家机构的连续的HCC（>7.0 cm）和主要PVTT患者，这些患者接受了Len+DEB-TACE+HAIC（Len+DEB-TACE+HAIC组）或Len+DEB-TACE（Len+DEB-TACE组）治疗。通过倾向评分匹配（PSM）比较两组的客观缓解率（ORR）、疾病进展时间（TTP）、总生存期（OS）和治疗相关不良事件（TRAEs）。
结果
共纳入205例患者。PSM后，研究队列中仍有85对患者。Len+DEB-TACE+HAIC组患者的ORR更高（61.2%对34.1%，P<0.001），TTP更长（中位数分别为9.8个月和5.9个月，P<0.001），OS更长（中位数分别为16.7个月和12.5个月，P<0.001），均高于Len+DEB-TACE组。Len+DEB-TACE+HAIC组肝内肿瘤的ORR和TTP（ORR：64.7%对36.5%，P<0.001；中位TTP：10.7个月对7.0个月，P<0.001）以及PVTT的ORR和TTP（ORR：74.1%对47.1%，P<0.001；中位TTP：17.4个月对7.6个月，P<0.001）均优于Len+DEB-TACE组。Len+DEB-TACE+HAIC组3-4级TRAEs的发生率与Len+DEB-TACE组相当（38.8%对34.1%，P=0.524）。
结论
Len+DEB-TACE联合HAIC较Len+DEB-TACE显著提高了ORR、TTP和OS，对于伴有主要PVTT的大型HCC具有可接受的安全性。
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