不可切除肝细胞癌靶向治疗中的不良事件可预测临床结局。

Adverse Events in Targeted Therapy for Unresectable Hepatocellular Carcinoma Predict Clinical Outcomes.

作者信息

Imai Kenji, Takai Koji, Aiba Masashi, Unome Shinji, Miwa Takao, Hanai Tatsunori, Suetsugu Atsushi, Shimizu Masahito

机构信息

Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.

出版信息

Cancers (Basel). 2024 Sep 14;16(18):3150. doi: 10.3390/cancers16183150.

DOI:10.3390/cancers16183150

PMID:39335121

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11430790/

Abstract

To assess the impact of adverse event (AE) severity, caused by targeted therapy, on overall survival (OS) and progression-free survival (PFS) in patients with unresectable hepatocellular carcinoma (HCC), a total of 183 patients with HCC treated with atezolizumab plus bevacizumab (40), lenvatinib (57), sorafenib (79), cabozantinib (3), ramucirumab (3), and regorafenib (1) were included in this study. Age-, AFP-, and ALBI score-adjusted hazard ratios (HRs) of AE grades 1 to 3 versus grade 0 for OS and PFS were calculated using Cox proportional hazards models. The linear trend of the HRs was assessed by calculating the values for this trend. The most common AEs were appetite loss (AE grade 0/1/2/3 = 97/23/55/12), general fatigue (102/31/44/6), hypertension (120/6/40/17), hand-foot syndrome (HFS) (135/21/24/3), proteinuria (140/13/16/14), and hypothyroidism (148/12/23/0). The adjusted HRs for OS of these AEs were 0.532-1.450-2.361 ( for trend 0.037), 1.057-1.691-3.364 ( for trend 0.004), 1.176-0.686-0.281 ( for trend 0.002), 0.639-0.759-1.820 ( for trend 0.462), 1.030-0.959-0.147 ( for trend 0.011), and 0.697-0.609 ( for trend 0.119), respectively. Those for PFS of the corresponding AEs were 0.592-1.073-2.811 ( for trend 0.255), 1.161-1.282-4.324 ( for trend 0.03), 0.965-0.781-0.655 ( for trend 0.095), 0.737-0.623-2.147 ( for trend 0.153), 1.061-0.832-0.800 ( for trend 0.391), and 1.412-0.560 ( for trend 0.081), respectively. Appetite loss and general fatigue negatively affected clinical outcomes, whereas hypertension, HFS, proteinuria, and hypothyroidism had positive effects.

摘要

为评估靶向治疗引起的不良事件（AE）严重程度对不可切除肝细胞癌（HCC）患者总生存期（OS）和无进展生存期（PFS）的影响，本研究纳入了183例接受阿替利珠单抗联合贝伐单抗（40例）、乐伐替尼（57例）、索拉非尼（79例）、卡博替尼（3例）、雷莫西尤单抗（3例）和瑞戈非尼（1例）治疗的HCC患者。使用Cox比例风险模型计算1至3级AE与0级AE相比，经年龄、甲胎蛋白（AFP）和白蛋白-胆红素（ALBI）评分调整后的OS和PFS风险比（HRs）。通过计算该趋势的值来评估HRs的线性趋势。最常见的AE为食欲减退（AE 0/1/2/3级 = 97/23/55/12）、全身乏力（102/31/44/6）、高血压（120/6/40/17）、手足综合征（HFS）（135/21/24/3）、蛋白尿（140/13/16/14）和甲状腺功能减退（148/12/23/0）。这些AE的OS调整后HRs分别为0.532 - 1.450 - 2.361（趋势 = 0.037）、1.057 - 1.691 - 3.364（趋势 = 0.004）、1.176 - 0.686 - 0.281（趋势 = 0.002）、0.639 - 0.759 - 1.820（趋势 = 0.462）、1.030 - 0.959 - 0.147（趋势 = 0.011）和0.697 - 0.609（趋势 = 0.119）。相应AE的PFS调整后HRs分别为0.592 - 1.073 - 2.811（趋势 = 0.255）、1.161 - 1.282 - 4.324（趋势 = 0.03）、0.965 - 0.781 - 0.655（趋势 = 0.095）、0.737 - 0.623 - 2.147（趋势 = 0.153）、1.061 - 0.832 - 0.800（趋势 = 0.391）和1.412 - 0.560（趋势 = 0.081）。食欲减退和全身乏力对临床结局有负面影响，而高血压、HFS、蛋白尿和甲状腺功能减退有正面影响。