Department of Radiation Oncology, Senior Department of Oncology, the Fifth Medical Center of PLA General Hospital, Beijing, China.
The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
Radiat Oncol. 2024 Oct 11;19(1):143. doi: 10.1186/s13014-024-02527-1.
The purpose of this study was to investigate the survival benefit of Stereotactic Body Radiotherapy (SBRT) versus lenvatinib as first-line therapy in the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT).
147 HCC patients with PVTT were included in this retrospective study, 70 were treated with SBRT and 77 of were treated with lenvatinib. Propensity score matching (PSM) analysis was employed to balance the differences in baseline characteristics between the two groups. Overall survival (OS), progression-free survival (PFS) and objective response rate (ORR) were compared between the two groups. In addition, the safety of patients in both groups was also evaluated.
After PSM, 38 patients were matched in each of the two groups. The median OS was 14.5 (95% CI: 10.1-18.9) and 11.1 (95% CI: 9.3-12.9) months in the SBRT and lenvatinib groups, respectively (P = 0.014). The median PFS was 6.8 (95% CI: 5.1-8.5) and 5.0 (95% CI: 3.0-7.0) months, respectively (P = 0.010). The 1-, 2-years OS rates in the two groups were 65.8% vs. 39.5% and 31.6% vs. 10.5%, respectively. The 6-, 12-months PFS rates in the two groups were 57.9% vs. 44.7% and 28.9% vs. 10.5%, respectively. In addition, the SBRT group had a better ORR than the lenvatinib group (52.6% vs. 23.7%, P = 0.009). Patients with good response to SBRT had better survival. Cox proportional hazard model showed that SBRT was an important prognostic factor for OS and PFS. The incidence of hypertension (34.2% vs. 0%) was higher in the LEN group, however, both treatment modalities were well tolerated in the two groups of patients.
In HCC patients with PVTT, SBRT had a better survival benefit than Lenvatinib treatment as first-line therapy.
本研究旨在探讨立体定向体部放射治疗（SBRT）与仑伐替尼作为一线治疗方案在伴有门静脉癌栓（PVTT）的肝细胞癌（HCC）患者中的生存获益。
本回顾性研究纳入了 147 例伴有 PVTT 的 HCC 患者，其中 70 例接受 SBRT 治疗，77 例接受仑伐替尼治疗。采用倾向评分匹配（PSM）分析平衡两组间基线特征的差异。比较两组患者的总生存期（OS）、无进展生存期（PFS）和客观缓解率（ORR）。此外，还评估了两组患者的安全性。
PSM 后，两组各匹配 38 例患者。SBRT 组和仑伐替尼组的中位 OS 分别为 14.5（95%CI：10.1-18.9）和 11.1（95%CI：9.3-12.9）个月（P=0.014）。中位 PFS 分别为 6.8（95%CI：5.1-8.5）和 5.0（95%CI：3.0-7.0）个月（P=0.010）。两组 1 年和 2 年 OS 率分别为 65.8%比 39.5%和 31.6%比 10.5%。两组 6 个月和 12 个月 PFS 率分别为 57.9%比 44.7%和 28.9%比 10.5%。此外，SBRT 组的 ORR 优于仑伐替尼组（52.6%比 23.7%，P=0.009）。对 SBRT 反应良好的患者生存获益更好。Cox 比例风险模型显示，SBRT 是 OS 和 PFS 的重要预后因素。高血压的发生率（34.2%比 0%）在 LEN 组较高，但两种治疗方法在两组患者中均耐受良好。
在伴有 PVTT 的 HCC 患者中，SBRT 作为一线治疗方案的生存获益优于仑伐替尼治疗。
