Analysis of the therapeutic efficacy of transcatheter arterial chemoembolization com-bined with systemic treatment in unresectable hepatocellular carcinoma
10.12354/j.issn.1000-8179.2023.20231001
- VernacularTitle:经肝动脉化疗栓塞联合系统治疗对不可切肝细胞癌的疗效分析
- Author:
Wenli LI
1
;
Yangfeng DU
;
Guosheng YUAN
;
Mengya ZANG
;
Peilin ZHU
;
Rong LI
;
Yongru CHEN
;
Kaiyan SU
;
Qi LI
;
Xiaoyun HU
;
Huajin PANG
;
Jinzhang CHEN
Author Information
1. 南方医科大学南方医院感染内科,器官衰竭防治国家重点实验室,华南传染病防治教育部重点实验室,广东省病毒性肝炎研究重点实验室,广东省病毒性肝炎临床医学研究中心,广东省肝脏疾病研究所(广州市 510515)
- Keywords:
hepatocellular carcinoma(HCC);
transcatheter arterial chemoembolization(TACE);
immune checkpoint inhibitors(ICIs);
tyr-osine kinase inhibitors(TKIs);
overall survival(OS);
progression-free survival(PFS)
- From:
Chinese Journal of Clinical Oncology
2023;50(22):1135-1141
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficacy and safety of different transcatheter arterial chemoembolization(TACE)-based regimens in patients with unresectable hepatocellular carcinoma(uHCC)and explore the optimal timing for combining TACE with tyrosine kinase inhibit-ors(TKIs)and immune checkpoint inhibitors(ICIs).Methods:A retrospective analysis was conducted on data from 555 patients with uHCC who underwent TACE-based treatment between April 2016 and December 2021 in Nanfang Hospital,Southern Medical University.The pa-tients were assigned into the following four groups according to different treatment regimens:TACE group(n=317),TACE combined with TKIs group(TACE+TKIs,n=66),TACE combined with ICIs group(TACE+ICIs,n=33),and TACE combined with TKIs+ICIs group(TACE+TKIs+ICIs,n=139).Subgroup analysis was performed within the TACE+TKIs+ICIs group,with patients being assigned into"pre-TACE"and"post-TACE"groups based on the timing of the combination therapy.Univariate and multivariate Cox regression analyses were conducted to identify pro-gnostic factors influencing overall survival(OS).Results:The TACE+TKIs+ICIs group showed the longest OS(21.9 months,95%confidence in-terval[CI]:17.2-26.6,P=0.030)and progression-free survival(PFS)(8.3 months,95%CI:7.3-9.3,P=0.004)compared to those in the other three groups.In the subgroup analysis,the"post-TACE"group had longer OS than the"pre-TACE"group(26.8 months vs.19.2 months,P = 0.011).The objective response rate(ORR)was 32.8%,41.1%,42.4%,and 52.5%(P=0.001)and the disease control rate(DCR)was 59.6%,71.2%,69.7%,and 82.7%(P<0.001)in the TACE,TACE+TKIs,TACE+ICIs,and TACE+TKIs+ICIs groups,respectively.The adverse events were similar to those reported in previous studies.Cox regression analysis revealed that tumor number,extrahepatic metastasis,and treatment regimen were independent factors influencing OS in patients(all P<0.05).Conclusions:TKIs or ICIs can improve OS and PFS in patients with uHCC receiving TACE,and the combination of TKIs+ICIs with TACE achieves better beneficial outcomes.The greatest OS was observed when the combination therapy TKIs+ICIs was initiated within 3 months after the first TACE procedure.
