经动脉化疗栓塞联合免疫和靶向药治疗Child-Pugh B级肝细胞癌研究  

Transarterial chemoembolization combined with immune checkpoint inhibitor and molecular targeted therapy for Child-Pugh grade B hepatocellular carcinoma

作　　者：陈荔[1] 吴大广 朱光宇[1] 仲斌演 郭金和[1] CHEN Li;WU Daguang;ZHU Guangyu;ZHONG Binyan;GUO Jinhe(Department of Interventional&Vascular Surgery,Affiliated Zhongda Hospital,Southeast University,Nanjing,Jiangsu Province 210009,China)

机构地区：[1]东南大学附属中大医院介入与血管外科,江苏南京210009 [2]盐城市阜宁县人民医院肿瘤科 [3]苏州大学附属第一医院介入科

出　　处：《介入放射学杂志》2024年第9期968-973,共6页Journal of Interventional Radiology

摘　　要：目的 探讨经动脉化疗栓塞(TACE)联合免疫检查点抑制剂(ICI)和分子靶向治疗对Child-Pugh(CP)分级B级肝细胞癌(HCC)的疗效和安全性。方法 筛选2018年1月至2021年5月在东南大学附属中大医院等3中心接受TACE联合ICI和分子靶向治疗(联合治疗组)或TACE单独治疗(单独治疗组)的CP B级HCC患者。主要终点为总生存期(OS),次要结局包括无进展生存期(PFS)、客观缓解率(ORR)和安全性。结果 126例患者纳入研究,其中联合治疗组64例,单独治疗组62例。联合治疗组、单独治疗组中位OS比较差异无统计学意义[17.7个月(95%CI:11.9~29.9)比13.2个月(95%CI:7.8~19.9),P=0.160],联合治疗组中CP评分7分患者获得了明显更好的OS[19.0个月(95%CI:13.6~NR)比13.2个月(95%CI:8.0~NR),P=0.024]。两组中位PFS、ORR比较差异均无统计学意义(P=0.720、P=0.960)。联合治疗组、单独治疗组分别有9例(14.1%)、6例(9.7%)患者出现3级/4级不良事件。结论 TACE联合免疫和靶向治疗CP B级HCC患者并未显示出比TACE单独治疗更好的预后,而联合治疗组CP评分7分患者OS明显更好。Objective To explore the clinical efficacy and safety of transarterial chemoembolization(TACE)combined with immune checkpoint inhibitor(ICI)and molecular targeted therapy for Child-Pugh grade B hepatocellular carcinoma(HCC).Methods The patients with Child-Pugh grade B HCC,who received TACE combined with ICI and molecular targeted therapy(combination group)or TACE monotherapy(monotherapy group)at the three medical centers including the Affiliated Zhongda Hospital of Southeast University of China between January 2018 and May 2021,were enrolled in this study.The primary outcome was overall survival(OS),and the secondary outcomes included progression-free survival(PFS),objective response rate(ORR),and clinical safety.Results A total of 126 patients were enrolled in this study,including 64 patients in the combination group and 62 patients in the monotherapy group.No statistically significant difference in median OS existed between the combination group and the monotherapy group[17.7 months(95%CI:11.9-29.9 months)vs.13.2 months(95%CI:7.8-19.9 months);P=0.160].In the combination group,the patients having a Child-Pugh score of 7 points obtained a significantly better OS[19.0months(95%CI:13.6-NR)vs.13.2 months(95%CI:8.0-NR),P=0.024].The differences in the median PFS and ORR between the two groups were not statistically significant(P=0.720 and P=0.960 respectively).GradeⅢ/Ⅳadverse events occurred in 19 patients(14.1%)of the combination group and in 6 patients(9.7%)of the monotherapy group.Conclusion In treating patients with Child-Pugh grade B HCC,TACE combined with ICI and molecular targeted therapy does not show a better prognosis than TACE monotherapy,however,the patients having a Child-Pugh score of 7 points in the combination group can have a much better OS.

关 键 词：肝细胞癌 经动脉化疗栓塞 Child-Pugh分级B级 

分 类 号：R735.7[医药卫生—肿瘤]