Kuo Li-Fu, Liu Wen-Chun, Li Ming-Feng, Huang Fu-Huan, Chou Chu-Kuang, Chen Tsung-Hsien, Tsai Yi-Tseng, Hsu Ping-I, Li Chao-Jen, Wu I-Ting, Tsai Kun-Feng
Gastroenterology and Hepatology Section, Department of Internal Medicine, An Nan Hospital, China Medical University, Tainan, Taiwan.
Department of Nursing, National Tainan Junior College of Nursing, Tainan, Taiwan.
Oncology. 2024 Oct 28:1-13. doi: 10.1159/000542291.
Patients with advanced-stage or intermediate-stage hepatocellular carcinoma (HCC) unsuitable for transarterial chemoembolization (TACE) had poor prognoses. Recent advancements in hepatic arterial infusion chemotherapy (HAIC) and immune checkpoint inhibitors (ICIs) have demonstrated higher tumor response rates, which improved overall survival (OS). HAIC achieves an OS rate of approximately 14.5-15.3 months with a 39.1-42.5% tumor response rate. In comparison, ICIs have a 12-14 month OS rate with a 26-33% tumor response rate. Given these promising responses, this study evaluates the efficacy of conversion therapy with curative intent following HAIC or ICIs, focusing on survival outcomes.
We retrospectively analyzed 80 patients with advanced or TACE-unsuitable intermediate HCC. Patients completed two HAIC or four ICI cycles, followed by Response Evaluation Criteria in Solid Tumors (RECIST) criteria imaging. Based on demographics, cirrhosis status, Barcelona Clinic Liver Cancer classification (BCLC) stage, treatment responses, and treatment modality, survival impacts were analyzed. OS was compared between HAIC and immunotherapy groups. The effect of conversion therapy with curative intent on survival outcomes was analyzed using a Cox regression model.
Among the 80 patients, 26 achieved positive response (CR/PR) with HAIC or ICIs, and 9 of them subsequently underwent conversion therapy with curative intent. Key prognostic factors included Child-Pugh stage B versus A (HR = 2.21, p = 0.041), BCLC stage C versus B (HR = 4.38, p = 0.011), and elevated alpha-fetoprotein levels (HR = 5.02, p < 0.001). Positive responders saw substantial survival benefits (HR = 0.26, p = 0.001). Patients undergoing conversion therapy exhibited significantly enhanced survival. Median OS was 13.58 months with standard therapy, while the curative intent surgery group did not reach the median OS (p = 0.002). For CR/PR patients, 48-month survival was 75.0% for the curative surgery group versus 38.0% for standard treatment.
Conversion therapy with curative intent following HAIC or ICIs might enhance survival in patients with advanced or TACE-unsuitable intermediate-stage HCC.
晚期或中期肝细胞癌（HCC）患者若不适用于经动脉化疗栓塞术（TACE），其预后较差。肝动脉灌注化疗（HAIC）和免疫检查点抑制剂（ICI）的最新进展已显示出更高的肿瘤缓解率，从而改善了总生存期（OS）。HAIC的总生存期约为14.5 - 15.3个月，肿瘤缓解率为39.1 - 42.5%。相比之下，ICI的总生存期为12 - 14个月，肿瘤缓解率为26 - 33%。鉴于这些令人鼓舞的缓解效果，本研究评估了HAIC或ICI后具有治愈意图的转化治疗的疗效，重点关注生存结果。
我们回顾性分析了80例晚期或不适用于TACE的中期HCC患者。患者完成两个HAIC周期或四个ICI周期，随后根据实体瘤疗效评价标准（RECIST）进行影像学检查。基于人口统计学、肝硬化状态、巴塞罗那临床肝癌分类（BCLC）分期、治疗反应和治疗方式，分析对生存的影响。比较HAIC组和免疫治疗组的总生存期。使用Cox回归模型分析具有治愈意图的转化治疗对生存结果的影响。
在这80例患者中，26例通过HAIC或ICI获得了阳性反应（完全缓解/部分缓解），其中9例随后接受了具有治愈意图的转化治疗。关键预后因素包括Child-Pugh B级与A级（HR = 2.21，p = 0.041）、BCLC C期与B期（HR = 4.38，p = 0.011）以及甲胎蛋白水平升高（HR = 5.02，p < 0.001）。阳性反应者有显著的生存获益（HR = 0.26，p = 0.001）。接受转化治疗的患者生存期显著延长。标准治疗的中位总生存期为13.58个月，而具有治愈意图的手术组未达到中位总生存期（p = 0.002）。对于完全缓解/部分缓解的患者，治愈性手术组的48个月生存率为75.0%，而标准治疗组为38.0%。
HAIC或ICI后具有治愈意图的转化治疗可能会提高晚期或不适用于TACE的中期HCC患者的生存率。
