Jin Ming, Jiang Zhi-Qing, Qin Jia-Hui, Qin Hui-Xia, Jiang Kai-Wen, Ya Hou-Xiang, Gu Jing, Gui Mo-Rui, Li Yao-Hua, Xu Long-Kuan, Fu Hai-Xiao, Xiao Xu-Hua, Li Shu-Qun
Department of Vascular Intervention, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, People's Republic of China.
Department of Gastrointestinal Surgery, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, People's Republic of China.
J Hepatocell Carcinoma. 2024 Nov 25;11:2309-2320. doi: 10.2147/JHC.S485047. eCollection 2024.
Transarterial chemoembolization (TACE) is recommended as a standard therapy for intermediate-stage hepatocellular carcinoma (HCC) and is the most widely used first-line treatment for advanced HCC. This study aimed to evaluate the clinical benefits and tolerability of TACE added to a combination of lenvatinib and programmed death-1 (PD-1) inhibitor in patients with unresectable HCC (uHCC).
We conducted a retrospective cohort study involving 144 patients with uHCC treated between August 2020 and August 2023. Patients received a combination of lenvatinib and a PD-1 inhibitor with or without TACE (T+L+P, n=81 or L+P, n=63, respectively). The baseline characteristics of the two groups were compared, and propensity score matching (PSM) was used to minimize bias. The study endpoints included overall survival (OS), progression-free survival (PFS), and objective response rate (ORR). Factors influencing survival rates were analyzed using Cox regression, and adverse events (AEs) were documented and assessed.
Before PSM, the T+L+P group showed significantly higher ORR (64.1% vs 44.4%, p < 0.05), longer median PFS (14.3 vs 9.6 months, p < 0.05), and longer median OS (24.6 vs 19.5 months, p < 0.05) compared to the L+P group. Even post-PSM, the T+L+P group showed significantly better OS and PFS compared to the L+P group (mOS: 28.0 vs 17.6 months p=0.0011, mPFS: 15.8 vs 9.3 months, p < 0.05). Univariate and multivariate analyses identified treatment options as independent factors for PFS and OS. The safety profile of the T+L+P regimen was acceptableThe incidence and severity of adverse reactions in the T+L+P group were not significantly different compared to the L+P group (any grade, 90.1 vs 93.6%, p=0.551; grade≥3, 25.9 vs 23.8%, p=0.843).
经动脉化疗栓塞术（TACE）被推荐作为中期肝细胞癌（HCC）的标准治疗方法，也是晚期HCC最广泛使用的一线治疗方法。本研究旨在评估TACE联合乐伐替尼和程序性死亡-1（PD-1）抑制剂对不可切除HCC（uHCC）患者的临床疗效和耐受性。
我们进行了一项回顾性队列研究，纳入了2020年8月至2023年8月期间接受治疗的144例uHCC患者。患者接受乐伐替尼和PD-1抑制剂联合治疗，联合或不联合TACE（分别为T+L+P组，n = 81；或L+P组，n = 63）。比较两组的基线特征，并采用倾向评分匹配（PSM）以尽量减少偏倚。研究终点包括总生存期（OS）、无进展生存期（PFS）和客观缓解率（ORR）。使用Cox回归分析影响生存率的因素，并记录和评估不良事件（AE）。
在PSM之前，与L+P组相比，T+L+P组的ORR显著更高（64.1%对44.4%，p < 0.05），中位PFS更长（14.3对9.6个月，p < 0.05），中位OS更长（24.6对19.5个月，p < 0.05）。即使在PSM之后，与L+P组相比，T+L+P组的OS和PFS仍显著更好（mOS：28.0对17.6个月，p = 0.0011；mPFS：15.8对9.3个月，p < 0.05）。单因素和多因素分析确定治疗方案是PFS和OS的独立因素。T+L+P方案的安全性可接受。T+L+P组不良反应的发生率和严重程度与L+P组相比无显著差异（任何级别，90.1%对93.6%，p = 0.551；≥3级，25.9%对23.8%，p = 0.843）。
