Xiao Jing, Li Qingdong, Zheng Wentao, Liao Kaiyou, Yu Qianwen, Huang Rongzhong, Zhou Rong
Precision Medicine Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, People's Republic of China.
J Hepatocell Carcinoma. 2025 Aug 14;12:1807-1819. doi: 10.2147/JHC.S523755. eCollection 2025.
The aim of this study was to evaluate the potential of partial transcatheter arterial embolization (pTAE)-hepatic artery infusion chemotherapy (HAIC) in combination with tyrosine kinase inhibitors (TKIs) and anti-PD-1 antibodies for downstaging and subsequent resection in patients with initially unresectable hepatocellular carcinoma (HCC).
Patients with unresectable HCC who underwent initial treatment with a combination of pTAE, HAIC, TKIs, and an anti-PD-1 antibody were studied. The tumour response and potential for resection were assessed through imaging every month (±1 week) using RECIST v1.1.
Among 17 patients (27.4%) who achieved R0 resection, the median time from quadruple therapy initiation to surgery was 89 days (range: 69-255). The cohort comprised 13 males and 4 females, with a median age of 51 years (range: 18-70). Twelve patients had BCLC stage C disease, including 11 with major vascular invasion (Vp2, Vp3, Vv2, Vv3, Vv1) and 3 with concurrent portal and hepatic venous invasion (Vp2/Vv2, Vp3/Vv2, Vp3/Vv3). Five patients had BCLC stage B HCC. The median diameter of the largest liver nodule was 11.5 cm (range: 3.9-18.8), with 10 patients presenting multiple lesions. Preoperatively, 17 patients underwent 43 cycles of pTAE-HAIC (median: 2, range: 1-5). Based on RECIST v1.1, 13 patients achieved partial response (PR), and 4 had stable disease (SD). With a median follow-up of 17.8 months (range: 12.2-38.3), the 12-month overall survival post-hepatectomy was 100%, and the median progression-free survival (PFS) was 14.5 months (range: 1.5-31.8). Tumor recurrence within 12 months occurred in 5 patients, with 4 achieving disease control after additional treatment.
Quadruple therapy, consisting of pTAE-HAIC combined with TKIs and anti-PD-1 antibodies, represents a feasible conversion strategy for patients with unresectable HCC to achieve successful resection and potential long-term survival.
本研究旨在评估部分经导管动脉栓塞术（pTAE）-肝动脉灌注化疗（HAIC）联合酪氨酸激酶抑制剂（TKIs）和抗程序性死亡蛋白1（PD-1）抗体对初始不可切除的肝细胞癌（HCC）患者进行降期并随后切除的可能性。
对接受pTAE、HAIC、TKIs和抗PD-1抗体联合初始治疗的不可切除HCC患者进行研究。每月（±1周）使用实体瘤疗效评价标准（RECIST）v1.1通过影像学评估肿瘤反应和切除可能性。
在17例（27.4%）实现R0切除的患者中，从四联疗法开始至手术的中位时间为89天（范围：69 - 255天）。该队列包括13名男性和4名女性，中位年龄为51岁（范围：18 - 70岁）。12例患者为巴塞罗那临床肝癌（BCLC）分期C期疾病，其中11例有大血管侵犯（Vp2、Vp3、Vv2、Vv3、Vv1），3例同时有门静脉和肝静脉侵犯（Vp2/Vv2、Vp3/Vv2、Vp3/Vv3）。5例患者为BCLC分期B期HCC。最大肝结节的中位直径为11.5 cm（范围：3.9 - 18.8 cm），10例患者有多个病灶。术前，17例患者接受了43个周期的pTAE-HAIC（中位值：2，范围：1 - 5））。根据RECIST v1.1，13例患者达到部分缓解（PR），4例疾病稳定（SD）。中位随访17.8个月（范围：12.2 - 38.3个月），肝切除术后12个月总生存率为100%，中位无进展生存期（PFS）为14.5个月（范围：1.5 - 31.8个月）。12个月内5例患者出现肿瘤复发，4例在接受额外治疗后实现疾病控制。
由pTAE-HAIC联合TKIs和抗PD-1抗体组成的四联疗法，是不可切除HCC患者实现成功切除和潜在长期生存的一种可行的转化策略。
