Liu Bowen, Yin Linan, Chen Yuxin, Hou Xunbo, Li Yingchen, Liu Xuesong, Liu Ruibao
Department of Interventional Radiology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China.
Front Oncol. 2025 Jul 29;15:1615506. doi: 10.3389/fonc.2025.1615506. eCollection 2025.
BACKGROUND: To evaluate the therapeutic efficacy and safety profile of combining transarterial chemoembolization (TACE) with hepatic arterial infusion chemotherapy (HAIC) combined with tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) in patients with hepatocellular carcinoma (HCC) classified as Barcelona Clinic Liver Cancer (BCLC) stage B or C. METHODS: This single-center retrospective analysis included patients with intermediate-to-advanced HCC diagnosed and treated between January 2020 and December 2023. Of 197 eligible patients meeting inclusion criteria, 103 were allocated to the TACE+HAIC+TKI+ICI (T+H+T+I) group and 94 to the HAIC+TKI+ICI (H+T+I) group. Propensity score matching (PSM) was employed to minimize confounding bias, yielding 50 patients per group in the final matched cohorts. Comparative analyses assessed overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR). Primary endpoints were OS and PFS; secondary endpoints included ORR and safety outcomes. RESULT: Among the 100 patients included in the analysis, 50 patients received T+H+T+I therapy while the remaining 50 underwent H+T+I treatment, with median follow-up durations of 13.1 months and 14.3 months, respectively. After PSM, the baseline characteristics showed no significant differences between the two groups. The T+H+T+I group demonstrated superior median overall survival (mOS) (20.77 months [95% CI: 11.37-30.16] vs 14.23 months [95% CI: 12.23-16.24]; =0.019) and longer median progression-free survival (mPFS) (15.43 months [95% CI: 11.85-19.02] vs 10.60 months [95% CI: 7.71-13.49]; <0.001) as assessed by modified Response Evaluation Criteria in Solid Tumors (mRECIST) version 1.1. The T+H+T+I regimen exhibited superior tumor control outcomes, with an ORR of 54% and DCR of 76%. However, this group also showed increased toxicity profiles, with 14 patients (28%) experiencing grade ≥3 adverse events. CONCLUSION: For patients with BCLC stage B-C HCC, the T+H+T+I combination therapy demonstrated superior survival benefits, particularly in those with tumor diameter ≥5 cm and presence of portal vein tumor thrombosis (PVTT), while maintaining an acceptable safety profile.
背景：评估经动脉化疗栓塞术（TACE）联合肝动脉灌注化疗（HAIC）以及酪氨酸激酶抑制剂（TKIs）和免疫检查点抑制剂（ICIs）治疗巴塞罗那临床肝癌（BCLC）分期为B或C期的肝细胞癌（HCC）患者的疗效和安全性。 方法：这项单中心回顾性分析纳入了2020年1月至2023年12月期间诊断并接受治疗的中晚期HCC患者。在197例符合纳入标准的合格患者中，103例被分配到TACE+HAIC+TKI+ICI（T+H+T+I）组，94例被分配到HAIC+TKI+ICI（H+T+I）组。采用倾向评分匹配（PSM）以尽量减少混杂偏倚，最终匹配队列中每组有50例患者。比较分析评估总生存期（OS）、无进展生存期（PFS）、客观缓解率（ORR）和疾病控制率（DCR）。主要终点为OS和PFS；次要终点包括ORR和安全性结果。 结果：纳入分析的100例患者中，50例接受T+H+T+I治疗，其余50例接受H+T+I治疗，中位随访时间分别为13.1个月和14.3个月。PSM后，两组的基线特征无显著差异。根据实体瘤改良疗效评价标准（mRECIST）1.1版评估，T+H+T+I组的中位总生存期（mOS）更长（20.77个月[95%CI：11.37 - 30.16] vs 14.23个月[95%CI：12.23 - 16.24]；P = 0.019），中位无进展生存期（mPFS）也更长（15.43个月[95%CI：11.85 - 19.02] vs 10.60个月[95%CI：7.71 - 13.49]；P < 0.001）。T+H+T+I方案显示出更好的肿瘤控制效果，ORR为54%，DCR为76%。然而，该组的毒性反应也有所增加，14例患者（28%）发生≥3级不良事件。 结论：对于BCLC B - C期HCC患者，T+H+T+I联合治疗显示出更好的生存获益，尤其是对于肿瘤直径≥5 cm且存在门静脉癌栓（PVTT）的患者，同时保持了可接受的安全性。
Ther Adv Med Oncol. 2024-1-27
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