放射治疗、酪氨酸激酶抑制剂、免疫检查点抑制剂联合肝动脉灌注化疗治疗伴有门静脉癌栓的肝细胞癌：RALOX方案与FOLFOX方案对比的倾向评分匹配队列研究
Radiotherapy, tyrosine kinase inhibitors, immune checkpoint inhibitors combined with hepatic arterial infusion chemotherapy of RALOX versus FOLFOX for hepatocellular carcinoma with portal vein tumor thrombus: a propensity score-matching cohort study.
作者信息
Tan Hao-Yang, Liu Shuang-Quan, Liu Yan-Han, Dai Guo-Hua, Zheng Jiu-Ling, Feng Hua-Guo
机构信息
Department of Hepatobiliary Surgery, the Chongqing University Jiangjin Hospital, School of Medicine, Chongqing University, Chongqing, China.
Department of Radiology, the Chongqing University Jiangjin Hospital, School of Medicine, Chongqing University, Chongqing, China.
出版信息
Discov Oncol. 2025 May 10;16(1):717. doi: 10.1007/s12672-025-02553-9.
BACKGROUND
This retrospective study aimed to evaluate the safety and effectiveness of hepatic arterial infusion chemotherapy with raltitrexed and oxaliplatin (RALOX-HAIC) combined with radiotherapy, tyrosine kinase inhibitors, and immune checkpoint inhibitors in patients with hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT).
METHODS
A propensity score-matching (PSM) cohort study was conducted. The tumor response, treatment-related adverse events, survival outcomes were compared. Univariate and multivariate analyses were conducted to explore the risk factors of overall survival (OS).
RESULTS
Twenty-one pairs of patients were evaluated after PSM. No statistical differences were found in the tumor response, objective response rate, disease control rate, PVTT response, surgical resection rate, metastasis, and mortality between the two groups before and after PSM. Compared with the FOLFOX-HAIC group, the incidences of abdominal pain and fever was lower in the RALOX-HAIC group (P = 0.028, P = 0.029). These differences still had statistical significance after PSM (P = 0.013, P = 0.014). No statistical differences were found in OS and progression-free survival (PFS) between the two groups before and after PSM (Before [OS: hazard ratio(HR) = 1.138; 95%CI 0.569-2.276, P = 0.715; PFS: HR = 0.549; 95%CI 0.195-1.548, P = 0.257; After [OS: HR = 0.998; 95%CI 0.438-2.274, P = 0.995; PFS: HR = 0.792; 95%CI 0.359-1.748, P = 0.564]). The prealbumin < 170 mg/L before therapy was an independent risk factor for OS (HR = 2.234; 95%CI 1.051-4.751; P = 0.037).
CONCLUSIONS
The RALOX-HAIC combined radiotherapy, TKI, and ICI may provide similar survival advantages with fewer treatment-related abdominal pain and fever compared to FOLFOX-HAIC for HCC patients with PVTT. The prealbumin < 170 mg/L before therapy is an independent risk factor for OS.
背景
本回顾性研究旨在评估雷替曲塞和奥沙利铂肝动脉灌注化疗（RALOX-HAIC）联合放疗、酪氨酸激酶抑制剂及免疫检查点抑制剂治疗伴有门静脉癌栓（PVTT）的肝细胞癌（HCC）患者的安全性和有效性。
方法
进行倾向评分匹配（PSM）队列研究。比较肿瘤反应、治疗相关不良事件及生存结局。进行单因素和多因素分析以探讨总生存（OS）的危险因素。
结果
PSM后评估了21对患者。PSM前后两组在肿瘤反应、客观缓解率、疾病控制率、PVTT反应、手术切除率、转移及死亡率方面均未发现统计学差异。与FOLFOX-HAIC组相比，RALOX-HAIC组腹痛和发热的发生率较低（P = 0.028，P = 0.029）。PSM后这些差异仍具有统计学意义（P = 0.013，P = 0.014）。PSM前后两组在OS和无进展生存（PFS）方面均未发现统计学差异（PSM前[OS：风险比（HR）= 1.138；95%置信区间0.569 - 2.276，P = 0.715；PFS：HR = 0.549；95%置信区间0.195 - 1.548，P = 0.257]；PSM后[OS：HR = 0.998；95%置信区间0.438 - 2.274，P = 0.995；PFS：HR = 0.792；95%置信区间0.359 - 1.748，P = 0.564]）。治疗前血清前白蛋白<170 mg/L是OS的独立危险因素（HR = 2.234；95%置信区间1.051 - 4.751；P = 0.037）。
结论
对于伴有PVTT的HCC患者，RALOX-HAIC联合放疗、TKI及ICI与FOLFOX-HAIC相比可能具有相似的生存优势，且治疗相关的腹痛和发热较少。治疗前血清前白蛋白<170 mg/L是OS的独立危险因素。
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