TACE联合TKI及PD-1抑制剂在不可切除肝细胞癌患者转化治疗中的疗效  

Efficacy of TACE combined with TKI and PD-1 inhibitors in conversion therapy for patients with unresectable hepatocellular carcinoma

作　　者：韦滔 唐置鸿 韦猛 林有智[1] 陈洁[1] 白涛[1] 王小波[1] 齐鲁楠[1] 唐娟[1] 黎乐群[1] 吴飞翔[1,2] WEI Tao;TANG Zhihong;WEI Meng;LIN Youzhi;CHEN Jie;BAI Tao;WANG Xiaobo;QI Lunan;TANG Juan;LI Lequn;WU Feixiang(Department of Hepatobiliary Surgery,Guangxi Medical University Cancer Hospital;Key Laboratory of High-Incidence-Tumor Prevention&Treatment and Splenogastric,Ministry of Education,Nanning 530021,China)

机构地区：[1]广西医科大学附属肿瘤医院肝胆胰脾外科,南宁530021 [2]区域性高发肿瘤早期防治研究教育部重点实验室

出　　处：《中国癌症防治杂志》2021年第4期413-419,共7页CHINESE JOURNAL OF ONCOLOGY PREVENTION AND TREATMENT

基　　金：国家自然科学基金项目(81860502);区域性高发肿瘤早期防治研究教育部重点实验室(GKE2019-06,GKE-ZZ202004)。

摘　　要：目的探讨经肝动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)联合酪氨酸激酶抑制剂(tyrosine kinase inhibitors,TKI)及程序性死亡受体-1(programmed death-1,PD-1)抑制剂在不可切除肝细胞癌患者转化治疗中的效果。方法收集和分析2019年11月至2020年12月于本院肝脏胰腺病区接受TACE联合TKI及PD-1抑制剂治疗的22例不可切除肝细胞癌患者的临床资料。主要研究终点为手术转化率,次要研究终点为肿瘤反应、客观缓解率、疾病控制率、无进展生存时间、总生存时间、不良反应等。结果22例患者的手术转化率为45.5%(10/22),客观缓解率为81.8%(18/22),疾病控制率为90.9%(20/22),中位无进展生存时间和中位总生存时间均未达到。治疗相关不良反应发生率为100%(22/22),其中≥3级不良反应发生率为59%(13/22)。10例转化治疗成功患者开始治疗至手术的中位时间为4.7个月(IQR:3.4~8.4个月),中位手术时间为271 min(IQR:210~313 min),中位出血量为225 mL(IQR:100~425 mL),术后中位引流管拔管时间为6.0 d(IQR:4.8~8.5 d),术后中位住院天数为10.0 d(IQR:8.5~12.3 d),3例获病理完全缓解,术后中位随访时间为3.5个月,均未见肿瘤复发和死亡。结论TACE联合TKI及PD-1抑制剂可能是不可切除肝细胞癌一种有效且安全的转化治疗策略。ObjectiveTo investigate the effect of transcatheter arterial chemoembolization(TACE)combined with tyrosine kinase inhibitors(TKI)and programmed death-1(PD-1)inhibitors in the conversion therapy for patients with unresectable hepatocellular carcinoma.MethodsClinical data of 22 patients with unresectable hepatocellular carcinoma receiving TACE combined with TKI and PD-1 inhibitors were collected and analyzed in the hepatocellular carcinoma ward of Guangxi Medical University Cancer Hospital from November 2019 to December 2020.The primary research endpoint was surgical conversion rate,and the secondary research endpoints were tumor response,objective response rate,disease control rate,progression-free survival,overall survival and poor response.ResultsAmong 22 patients,the surgical conversion rate was 45.5%(10/22),the objective remission rate was 81.8%(18/22),and the disease control rate was 90.9%(20/22).The median progression-free survival and the median overall survival did not reach the observation endpoint.The incidence of treatment-related adverse reactions(TRAE)was 100%(22/22),and the incidence of≥3 grade TRAE was 59%(13/22).Among the 10 patients with successful conversion therapy,the median time from treatment to surgery was 4.7 months(IQR:3.4-8.4 months),the median operation time was 271 min(IQR:210-313 min),the median blood loss was 225 mL(IQR:100-425 mL),the postoperative median drainagetube extubation time was 6.0 d(IQR:4.8-8.5 d),and the median postoperative hospital stay was 10.0 d(IQR:8.5-12.3 d);3 cases had complete remission;the median follow-up time after operation was 3.5 months,and no tumor recurrence or death was found.ConclusionsTACE combined with TKI and PD-1 inhibitors may be an effective and safe conversion therapy strategy for unresectable hepatocellular carcinoma.

关 键 词：肝细胞癌 不可切除 TACE TKI PD-1 转化治疗 

分 类 号：R735.7[医药卫生—肿瘤]