Curative effect of programmed death-1 inhibitor combined with drug-eluting beads-transcatheter arterial chemoembolization and radiofrequency ablation in the treatment of older patients with primary hepatocellular carcinoma
10.3760/cma.j.issn.0254-9026.2025.11.010
- VernacularTitle:程序性死亡-1抑制剂联合药物洗脱微球肝动脉化疗栓塞和射频消融治疗老年人原发性肝癌的疗效
- Author:
Zhenhua TIAN
1
;
Kun WANG
;
Feng CAI
;
Yinmou GUO
;
Wenguang ZHANG
Author Information
1. 商丘市第一人民医院介入科，商丘 476100
- Publication Type:Journal Article
- Keywords:
Liver neoplasms;
Programmed death-1;
Hepatic artery perfusion chemotherapy;
Radiofrequency ablation
- From:
Chinese Journal of Geriatrics
2025;44(11):1536-1541
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the therapeutic efficacy of programmed death-1(PD-1)inhibitors in combination with drug-eluting beads transcatheter arterial chemoembolization(DEB-TACE)and radiofrequency ablation(RFA), as well as their impact on the prognosis of older patients with primary hepatocellular carcinoma(HCC).Methods:In this prospective cohort study, 120 patients aged 65 years and older with HCC at stage Ⅱb-Ⅲb were randomly assigned to an observation group (n=60)and a control group (n=60)between January 2021 and January 2024.The control group received DEB-TACE followed by RFA, while the observation group received a PD-1 inhibitor in combination with DEB-TACE followed by RFA, with both interventions lasting for 12 weeks.The clinical efficacy of the treatments in both groups was assessed, and changes in serum tumor markers before and after treatment were compared between the two groups.Safety was evaluated, survival data were recorded during follow-up, and the effects of different therapeutic regimens on patient prognosis were analyzed.Results:The disease control rate(DCR)and objective response rate(ORR)in the observation group were 88.33% and 78.33%, respectively, which were higher than those in the control group (71.67% and 28.33%, χ2=5.208, 30.134, P=0.022, <0.001). After treatment, levels of serum tumor markers (alpha fetoprotein, carbohydrate antigen 125, vascular endothelial growth factor)decreased in both groups (all P<0.05), with levels in the observation group being lower than those in the control group (all P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (all P>0.05). By the end of follow-up, which ranged from 2 to 33 months, there were 15 death cases in the observation group, resulting in a cumulative survival rate of 75.00%(45/60) and a mean survival of 25.95 months.In the control group, there were 25 death cases, with a cumulative survival rate of 58.33%(35/60)and a mean survival of 20.33 months.The results of the Kaplan-Meier function analysis were as follows: Log-rank χ2=5.747, P=0.017; Breslow χ2=3.124, P=0.077.The results of the multivariate Cox regression analysis indicated that PD-1 inhibitor combined with DEB-TACE sequential RFA was a protective factor against death in older patients with primary HCC( HR=0.680, 95% CI: 0.463-0.998, P=0.014). Conclusions:The curative effect and safety of PD-1 inhibitor combined with DEB-TACE and RFA are favorable in older patients with advanced HCC.
