放射治疗联合免疫检查点抑制剂及仑伐替尼治疗肝细胞癌合并门静脉癌栓的疗效分析  

Long-term outcomes of radiotherapy combined with immune checkpoint blockade inhibitor and lenvatinib therapy in hepatocellular carcinoma with portal vein tumor thrombus

作　　者：赵莹[1] 黎可人 杨艳美 李微[3] 李广欣 黎功 Zhao Ying;Li Kewei;Yang Yanmei;Li Wei;Li Guangxin;Li Gong(Department of Radiation Oncology,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China;Hepatopancreatobiliary Center,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China;Department of Clinical Trials Center,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)

机构地区：[1]清华大学临床医学院/清华大学附属北京清华长庚医院放疗科,北京102218 [2]清华大学临床医学院/清华大学附属北京清华长庚医院肝胆胰中心,北京102218 [3]清华大学临床医学院/清华大学附属北京清华长庚医院GCP中心,北京102218

出　　处：《肝癌电子杂志》2023年第3期58-63,共6页Electronic Journal of Liver Tumor

摘　　要：目的:探索放射治疗(简称放疗)联合免疫检查点抑制剂(PD-1抑制剂)及仑伐替尼治疗合并门静脉主干或一级分支瘤栓的肝细胞癌(HCC)患者的疗效及安全性。方法:选取2018年3月至2020年10月北京清华长庚医院收治的不可切除且未接受过系统治疗的巴塞罗那临床肝癌分期(BCLC)C期的HCC,且伴Vp3、Vp4型门静脉癌栓(PVTT)患者。研究终点主要为3年总生存(OS)率、无进展生存(PFS)率及PVTT的客观有效率。采用Kaplan-Meier生存分析和log-rank检验。结果:共47例患者入组,其中39例为Vp4型PVTT。全组中位随访时间33.9个月(3.1~57.1个月),中位OS期为11.9个月(95%CI为7.5~16.3个月),3年OS率为18%;中位PFS期为5个月(95%CI为3.5~6.5个月),3年PFS率为10%。Vp4型患者中位OS期为9.4个月(95%CI为8.3~10.5个月),3年OS率为13%,中位PFS期为4.9个月(95%CI为3.2~6.6个月),3年PFS率为9%。PVTT客观有效率为75%。全组无3级以上不良反应发生。结论:放疗联合PD-1抑制剂及仑伐替尼对合并门静脉主干或一级分支瘤栓的HCC患者远期疗效较好且不良反应可控,该三联疗法可能成为BCLC C期HCC治疗的优选方法之一。Objective:To explore the efficacy and safety of radiotherapy combined with immune checkpoint blockade inhibitor(PD-1 inhibitor)and lenvatinib in hepatocellular carcinoma(HCC)patients with portal vein tumor thrombus(PVTT).Methods:Between March 2018 to October 2020,patients diagnosed with unresectable HCC with PVTT who were admitted to our hospital were screened.In whom we included patients who met Barcelona Clinic Liver Cancer(BCLC)stage C,with Vp3 or Vp4 type portal vein tumor thrombus,and had no prior systemic treatment.The primary endpoints were 3-year overall survival(OS),progression-free survival(PFS),and objective response rate(ORR)of PVTT.Kaplan-Meier analysis was used for survival analysis and log-rank test was performed.Results:47 patients were enrolled in the study,39 of whom had Vp4 type PVTT.The median follow-up duration was 33.9(range:3.1-57.1)months.The median OS tuime was 11.9(95%CI:7.5-16.3)months,and the 3-year OS rate was 18%.The median PFS tiume was 5 months(95%CI:3.5-6.5 months),and the 3-year PFS rate was 10%.Among patients with Vp4 type PVTT,the median OS time was 9.4 months(95%CI:8.3-10.5 months),and the 3-year OS rate was 13%.The median PFS time was 4.9 months(95%CI:3.2-6.6 months),and the 3-year PFS rate was 9%.The objective response rate of PVTT was 75%.No grade 3 or higher adverse events occurred.Conclusions:Radiotherapy combined with PD-1 inhibitor and lenvatinib in HCC patients with PVTT demonstrated favorable long-term efficacy and low toxicity.This triple combination therapy may become one of the competitive treatment options for HCC with BCLC stage C.

关 键 词：肝细胞癌 门静脉癌栓 放射治疗 程序化死亡受体-1抑制剂 仑伐替尼 

分 类 号：R735.7[医药卫生—肿瘤]