南方医科大学学报

南方医科大学学报 ›› 2024, Vol. 44 ›› Issue (9): 1831-1838.doi: 10.12122/j.issn.1673-4254.2024.09.24

• • 上一篇    

经动脉化疗栓塞续贯肝动脉灌注化疗联合TKI和PD-1单抗在晚期肝癌一线治疗中的疗效观察

张力苹1,2(), 刘喜娟2, 胡潇2, 王嘉丽2, 余锡贺2, 栗国梁2, 游海敏2, 张启周2, 张海波1()   

  1. 1.广州中医药大学第二临床医学院（广东省中医院） 肿瘤科，广东 广州 510405
    2.广州中医药大学附属广东中西医结合医院（广东省中西医结合医院）肿瘤科，广东 佛山 528200
  • 收稿日期:2023-11-25 出版日期:2024-09-20 发布日期:2024-09-30
  • 通讯作者: 张海波 E-mail:252768046@qq.com;haibozh@gzucm.edu.cn
  • 作者简介:张力苹，在读博士研究生，主任医师，E-mail: 252768046@qq.com
  • 基金资助:
    2020年佛山科技局医学类科技攻关项目(2020001004649)

Efficacy and safety of transcatheter arterial chemoembolization followed by hepatic arterial infusion chemotherapy combined with TKI and PD-1 inhibitors as first-line treatment for advanced hepatocellular carcinoma

Liping ZHANG1,2(), Xijuan LIU2, Xiao HU2, Jiali WANG2, Xihe YU2, Guoliang LI2, Haimin YOU2, Qizhou ZHANG2, Haibo ZHANG1()   

  1. 1.Department of Oncology, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510405, China
    2.Department of Oncology, Affiliated Guangdong Hospital of Integrated Traditional Chinese and Western Medicine of Guangzhou University of Chinese Medicine, Foshan 528200, China
  • Received:2023-11-25 Online:2024-09-20 Published:2024-09-30
  • Contact: Haibo ZHANG E-mail:252768046@qq.com;haibozh@gzucm.edu.cn

RichHTML

3

PDF

535

摘要：

目的 探讨经动脉化疗栓塞（TACE）续贯肝动脉灌注化疗（HAIC）基础上联合抗血管生成的酪氨酸激酶抑制剂（TKI）药物和程序化细胞死亡蛋白抑制剂（PD-1 inhibitors）一线治疗晚期肝癌（HCC）患者的有效性和安全性。 方法 回顾性分析2020年7月~2023年6月广东省中西医结合医院肿瘤科收治且资料完整的70例晚期HCC患者，按其治疗方案进行分组，分为TACE+HAIC+靶向组（TACE序贯HAIC，联合TKI，共23例）和TACE+HAIC+免疫+靶向组（TACE序贯HAIC，联合PD-1抑制剂以及TKI，共47例）。收集患者临床特征、辅助检查资料、疗效评估及其他治疗相关资料等，进行疗效及不良反应相关统计分析。 结果 TACE+HAIC+靶向组、TACE+HAIC+免疫+靶向组的客观缓解率（ORR）分别为60.87%和36.17%（P=0.031），疾病控制率（DCR）分别为95.65%和93.62%（P=0.068）；2组患者中位无疾病进展时间（PFS）时间分别为10.2月、11.8月（P=0.003），中位总生存时间（OS）时间分别为15.7月、19.5月（P=0.035）。经倾向性匹配（PSM）分析后，TACE+HAIC+靶向、TACE+HAIC+免疫+靶向组中位PFS分别为10.1月和14.5月（P=0.024），中位OS分别为14.1月和21.2月（P=0.221）。TACE+HAIC+靶向组、TACE+HAIC+免疫+靶向组患者1年PFS率分别为24.0%和52.2%，1年OS率分别为72.3%和93.1%、2年OS率分别为23.9%和63.8%、3年OS率分别为23.9%和36.5%。TACE+HAIC+免疫+靶向组的蛋白尿发生率高于TACE+HAIC+靶向组（21.28% vs 0，P=0.025）；但2组患者任何3~4级TRAE发生率无统计学差异。 结论 TACE+HAIC+免疫+靶向治疗晚期HCC安全有效，可延长晚期HCC患者生存期。

关键词: 晚期肝癌, 无进展生存期, 总生存期, TACE, HAIC, TKI, PD-1单抗

Abstract:

Objective To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) followed by hepatic arterial infusion chemotherapy (HAIC) combined with TKI drugs and PD-1 inhibitors as the first-line treatment for advanced hepatocellular carcinoma (HCC). Methods We retrospectively analyzed the data of 70 patients with advanced HCC treated in the Department of Oncology of Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine between July, 2020 and June, 2023. 23 of the patients received TACE combined with HAIC and TKI (TACE+HAIC+TKI group) and 47 received TACE combined with HAIC, PD-1 inhibitors and TKI (TACE+HAIC+PD-1+TKI group). The clinical characteristics, laboratory test results, efficacy, outcomes and adverse events of the patients were compared between the two groups. Results The TACE+HAIC+TKI and TACE+HAIC+PD-1+TKI groups had significantly different objective remission rates (ORR; 60.87% vs 36.17%, P=0.031), comparable disease control rates (95.65% vs 93.62%, P=0.068), and different median progression-free survival (PFS) time (10.2 vs 11.8 months, P=0.003) and median overall survival (OS) time (15.7 vs 19.5 months, P=0.035). After propensity score matching (PSM), the median PFS and OS time of the two groups was 10.1 vs 14.5 months (P=0.024) and 14.2 vs 21.2 months (P=0.221), respectively. The 1-year PFS rates of the 2 groups were 24.0% vs 52.2%, and the 1-, 2- and 3-year OS rates were 72.3% vs 93.1%, 23.9% vs 63.8%, and 23.9% vs 36.5%, respectively. The incidence of proteinuria was significantly higher in TACE+HAIC+PD-1+TKI group than in TACE+HAIC+TKI group (21.28% vs 0, P=0.025), but the incidences of grade 3-4 treatment-related adverse events were all similar between the two groups. Conclusion The first-line treatment with TACE+HAIC+PD-1+TKI is safe and effective for advanced HCC and can significantly prolong the survival of the patients.

Key words: advanced hepatocellular carcinoma, progression-free survival, overall survival, transcatheter arterial chemoembolization, hepatic arterial infusion chemotherapy, TKI, PD-1 inhibitors