接受免疫检查点抑制剂和抗血管内皮生长因子抗体/酪氨酸激酶抑制剂治疗（无论是否联合经动脉化疗栓塞）的晚期肝细胞癌患者的肝功能动态变化

Liver function dynamics in advanced hepatocellular carcinoma receiving immune checkpoint inhibitors and anti-vascular endothelial growth factor antibody/tyrosine kinase inhibitors with or without transarterial chemoembolization.

作者信息

Liu Chen-You, Wang Meng-Fan, Xu Xiao-Yang, Wu Hao-Dong, Wang Ze, Zhang Shuai, Shen Jian, Zhu Xiao-Li

机构信息

Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.

Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Street, Suzhou, Jiangsu 215006, People's Republic of China.

出版信息

Ther Adv Med Oncol. 2025 Jun 30;17:17588359251347363. doi: 10.1177/17588359251347363. eCollection 2025.

BACKGROUND

The efficacy and safety of transarterial chemoembolization (TACE) combined with immune checkpoint inhibitors (ICIs) and anti-vascular endothelial growth factor (anti-VEGF) antibody/tyrosine kinase inhibitors (TKIs) have been established. However, it remains unclear whether the addition of TACE to systemic therapies exacerbates liver function deterioration and increases mortality risk.

OBJECTIVES

To assess liver function changes and their impact on prognosis in patients with advanced hepatocellular carcinoma (HCC) treated with ICIs and anti-VEGF antibody/TKIs with or without TACE as first-line therapy.

DESIGN

This is a real-world retrospective cohort study.

METHODS

Patients with advanced HCC treated with TACE combined with ICIs and anti-VEGF antibody/TKIs (TACE-ICI-VEGF) or ICIs and anti-VEGF antibody/TKIs alone (ICI-VEGF) from January 2018 to June 2024 were retrospectively included. The primary outcomes were changes in albumin-bilirubin (ALBI) score and time to deterioration (TTD) of liver function. The secondary outcomes included overall survival (OS), progression-free survival (PFS), and the relationship between TTD and prognosis.

RESULTS

A total of 111 patients were included, with 54 and 57 patients receiving TACE-ICI-VEGF and ICI-VEGF, respectively. Changes in ALBI score were similar between groups (difference in least squares mean, -0.075; 95% confidence interval (CI): -0.298 to 0.148). TTD was also comparable (median for TACE-ICI-VEGF 9.7 months vs. ICI-VEGF 8.5 months; hazard ratio (HR) = 1.19 (95% CI: 0.71-2.01); = 0.512). TACE-ICI-VEGF group demonstrated a significantly improved median OS (18.3 vs. 11.8 months; HR = 0.60 (95% CI: 0.37-0.98); = 0.041) and a trend toward prolonged median PFS (14.7 vs. 11.2 months; HR = 0.76 (95% CI: 0.47-1.25); = 0.278). Patients with liver function deterioration had an increased risk of mortality (median OS: 13.2 vs. 17.0 months; HR = 1.44 (95% CI: 0.88-2.35); = 0.139).

CONCLUSION

TACE combined with ICIs plus anti-VEGF antibodies/TKIs as first-line treatment generally did not adversely affect liver function. Liver function deterioration was associated with an increased risk of mortality.

背景

经动脉化疗栓塞术（TACE）联合免疫检查点抑制剂（ICIs）及抗血管内皮生长因子（抗VEGF）抗体/酪氨酸激酶抑制剂（TKIs）的疗效和安全性已得到证实。然而，在全身治疗中加用TACE是否会加剧肝功能恶化并增加死亡风险仍不明确。

目的

评估接受ICIs及抗VEGF抗体/TKIs一线治疗的晚期肝细胞癌（HCC）患者，在接受或不接受TACE治疗时的肝功能变化及其对预后的影响。

设计

这是一项真实世界的回顾性队列研究。

方法

回顾性纳入2018年1月至2024年6月接受TACE联合ICIs及抗VEGF抗体/TKIs（TACE-ICI-VEGF）或仅接受ICIs及抗VEGF抗体/TKIs（ICI-VEGF）治疗的晚期HCC患者。主要结局为白蛋白-胆红素（ALBI）评分变化及肝功能恶化时间（TTD）。次要结局包括总生存期（OS）、无进展生存期（PFS）以及TTD与预后的关系。

结果

共纳入111例患者，其中54例和57例分别接受TACE-ICI-VEGF和ICI-VEGF治疗。两组间ALBI评分变化相似（最小二乘均值差异为-0.075；95%置信区间（CI）：-0.298至0.148）。TTD也相当（TACE-ICI-VEGF组中位数为9.7个月，ICI-VEGF组为8.5个月；风险比（HR）=1.19（95%CI：0.71-2.01）；P=0.512）。TACE-ICI-VEGF组的中位OS显著改善（18.3个月对11.8个月；HR=0.60（95%CI：0.37-0.98）；P=0.041），且中位PFS有延长趋势（14.7个月对11.2个月；HR=0.76（95%CI：0.47-1.25）；P=0.278）。肝功能恶化的患者死亡风险增加（中位OS：13.2个月对17.0个月；HR=1.44（95%CI：0.88-2.35）；P=0.139）。