肝动脉灌注化疗与经动脉放射性栓塞治疗不可切除的结直肠癌肝转移的比较

Hepatic Artery Infusion Chemotherapy Compared to Transarterial Radioembolization For Unresectable Colorectal Liver Metastases.

作者信息

Saadat Lily V, Chou Joanne, Gonen Mithat, Lee Rachel M, Maithel Shishir K, Li Amy, Poultsides George A, Aiken Taylor J, Schwartz Patrick B, Meram Ece, Abbott Daniel E, Robbins Keenan J, Fields Ryan C, Paranjpe Ashwini, Datta Jashodeep, Connell Louise C, Saltz Leonard, Cercek Andrea, Kemeny Nancy, Sze Daniel Y, Yarmohammadi Hooman, Sofocleous Constantinos T, Jarnagin William, D'Angelica Michael

机构信息

Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.

Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.

出版信息

Ann Surg. 2025 Jul 25. doi: 10.1097/SLA.0000000000006851.

DOI:10.1097/SLA.0000000000006851

PMID:40709764

Abstract

OBJECTIVE

This study evaluates outcomes for patients with unresectable colorectal liver metastases (CRLM) undergoing hepatic artery infusion chemotherapy (HAI) and transarterial radioembolization (TARE).

SUMMARY BACKGROUND DATA

The most common liver-directed therapies for unresectable CRLM include HAI and TARE.

METHODS

In this retrospective cohort study, patients with unresectable CRLM treated with HAI at one high-volume center were compared with patients treated with TARE at five other institutions. Propensity score matching was performed within lines of chemotherapy received prior to treatment (treatment-naïve; 1-line; 2-lines; 3-4 lines) using baseline demographics, extrahepatic disease (EHD), prior chemotherapy, disease-free interval, and interval from primary diagnosis to HAI/TARE. Overall survival (OS) analysis was conducted to compare the matched groups.

RESULTS

A total of 708 HAI patients and 481 TARE patients were identified. The majority of patients (84%) received chemotherapy prior to HAI/TARE. HAI patients were younger (median age:54 vs. 62) and more likely to have evidence of EHD at time of treatment (65% vs. 60%). Of the 493 patients who received 1-line of chemotherapy, 166 (34%) were matched. Among matched patients who received 1-line (HAI:83, TARE:83) or 2-lines of chemotherapy (HAI:80, TARE:80), TARE patients had a significantly increased risk of all-cause mortality compared to HAI [HR:1.46 (95%CI:1.02-2.08) and HR:1.96 (95%CI:1.32-2.89)]. More frequent conversion to resection and use of concurrent systemic chemotherapy were also seen in the HAI cohort. Among matched patients who received 3-4 lines of chemotherapy (HAI:50, TARE:50), there was no difference in OS between HAI and TARE [HR:0.88 (95%CI:0.57-1.35)] and rate of conversion to surgery was 4% for both groups.

CONCLUSIONS

Within matched cohorts stratified by lines of therapy, there appear to be differences in survival for patients treated with HAI and TARE after first or second-line chemotherapy. Outcomes after TARE and HAI are not significantly different in the refractory setting.

摘要

目的

本研究评估接受肝动脉灌注化疗（HAI）和经动脉放射性栓塞（TARE）的不可切除结直肠癌肝转移（CRLM）患者的治疗结果。

总结背景数据

针对不可切除CRLM最常用的肝脏定向治疗方法包括HAI和TARE。

方法

在这项回顾性队列研究中，将一家大型中心接受HAI治疗的不可切除CRLM患者与其他五家机构接受TARE治疗的患者进行比较。使用基线人口统计学、肝外疾病（EHD）、既往化疗、无病间期以及从初次诊断到HAI/TARE的时间间隔，在治疗前接受的化疗线数（未接受过治疗；1线；2线；3 - 4线）内进行倾向评分匹配。进行总生存（OS）分析以比较匹配组。

结果

共识别出708例HAI患者和481例TARE患者。大多数患者（84%）在接受HAI/TARE之前接受过化疗。HAI组患者更年轻（中位年龄：54岁对62岁），且在治疗时更有可能有EHD证据（65%对60%）。在接受1线化疗的493例患者中，166例（34%）进行了匹配。在接受1线（HAI：83例，TARE：83例）或2线化疗（HAI：80例，TARE：80例）的匹配患者中，与HAI相比，TARE患者全因死亡风险显著增加[风险比（HR）：1.46（95%置信区间：1.02 - 2.08）和HR：1.96（95%置信区间：1.32 - 2.89）]。HAI队列中转为切除术的频率更高，同时使用全身化疗的情况也更多。在接受3 - 4线化疗的匹配患者中（HAI：50例，TARE：50例），HAI和TARE之间的OS无差异[HR：0.88（95%置信区间：0.57 - 1.35）]，两组转为手术的比例均为4%。