Prognostic Evaluation of Conversion Therapy following Hepatic Arterial Infusion Chemotherapy or Immunotherapy in Patients with Advanced or Transarterial Chemoembolization Unsuitable Intermediate-Stage Hepatocellular Carcinoma: A Retrospective Cohort Study.

IF 2.5 3区医学 Q3 ONCOLOGY Oncology Pub Date : 2024-10-28 DOI:10.1159/000542291

Li-Fu Kuo, Wen-Chun Liu, Ming-Feng Li, Fu-Huan Huang, Chu-Kuang Chou, Tsung-Hsien Chen, Yi-Tseng Tsai, Ping-I Hsu, Chao-Jen Li, I-Ting Wu, Kun-Feng Tsai

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引用次数: 0

Abstract

Introduction: Patients with advanced-stage or intermediate-stage hepatocellular carcinoma (HCC) unsuitable for transarterial chemoembolization (TACE) had poor prognoses. Recent advancements in hepatic arterial infusion chemotherapy (HAIC) and immune checkpoint inhibitors (ICIs) have demonstrated higher tumor response rates, which improved overall survival (OS). HAIC achieves an OS rate of approximately 14.5-15.3 months with a 39.1-42.5% tumor response rate. In comparison, ICIs have a 12-14 month OS rate with a 26-33% tumor response rate. Given these promising responses, this study evaluates the efficacy of conversion therapy with curative intent following HAIC or ICIs, focusing on survival outcomes.

Methods: We retrospectively analyzed 80 patients with advanced or TACE-unsuitable intermediate HCC. Patients completed two HAIC or four ICI cycles, followed by Response Evaluation Criteria in Solid Tumors (RECIST) criteria imaging. Based on demographics, cirrhosis status, Barcelona Clinic Liver Cancer classification (BCLC) stage, treatment responses, and treatment modality, survival impacts were analyzed. OS was compared between HAIC and immunotherapy groups. The effect of conversion therapy with curative intent on survival outcomes was analyzed using a Cox regression model.

Results: Among the 80 patients, 26 achieved positive response (CR/PR) with HAIC or ICIs, and 9 of them subsequently underwent conversion therapy with curative intent. Key prognostic factors included Child-Pugh stage B versus A (HR = 2.21, p = 0.041), BCLC stage C versus B (HR = 4.38, p = 0.011), and elevated alpha-fetoprotein levels (HR = 5.02, p < 0.001). Positive responders saw substantial survival benefits (HR = 0.26, p = 0.001). Patients undergoing conversion therapy exhibited significantly enhanced survival. Median OS was 13.58 months with standard therapy, while the curative intent surgery group did not reach the median OS (p = 0.002). For CR/PR patients, 48-month survival was 75.0% for the curative surgery group versus 38.0% for standard treatment.

Conclusion: Conversion therapy with curative intent following HAIC or ICIs might enhance survival in patients with advanced or TACE-unsuitable intermediate-stage HCC.

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晚期或不适合经动脉化疗栓塞术的中晚期肝细胞癌患者接受肝动脉灌注化疗或免疫疗法后转换疗法的预后评估--一项回顾性队列研究。

简介不适合经动脉化疗栓塞术（TACE）的晚期或中期肝细胞癌（HCC）患者预后较差。肝动脉灌注化疗（HAIC）和免疫检查点抑制剂（ICIs）的最新进展证明了更高的肿瘤反应率，从而提高了总生存率（OS）。HAIC 的 OS 率约为 14.5-15.3 个月，肿瘤反应率为 39.1-42.5%。相比之下，ICIs 的 OS 率为 12-14 个月，肿瘤反应率为 26-33%。鉴于这些有希望的反应，本研究评估了 HAIC 或 ICI 后以治愈为目的的转换疗法的疗效，重点关注生存结果：我们对 80 例晚期或不适合 TACE 的中度 HCC 患者进行了回顾性分析。患者完成了两个 HAIC 或四个 ICI 周期，随后进行了实体瘤反应评估标准（RECIST）成像。根据人口统计学、肝硬化状态、巴塞罗那临床肝癌分类（BCLC）分期、治疗反应和治疗方式，对生存影响进行了分析。比较了HAIC组和免疫治疗组的OS。使用Cox回归模型分析了治愈性转换疗法对生存结果的影响：结果：在80名患者中，有26人在接受HAIC或ICIs治疗后获得了阳性反应（CR/PR），其中9人随后接受了以治愈为目的的转换疗法。主要预后因素包括Child-Pugh B期与A期（HR=2.21，p=0.041）、BCLC C期与B期（HR=4.38，p=0.011）以及AFP水平升高（HR=5.02，p<0.001）。阳性反应者的生存率大幅提高（HR=0.26，p=0.001）。接受转换疗法的患者生存率明显提高。标准疗法的中位生存期为13.58个月，而治愈性手术组未达到中位生存期（P=0.002）。对于CR/PR患者，治愈性手术组的48个月生存率为75.0%，而标准治疗组为38.0%：结论：HAIC 或 ICIs 治疗后，以治愈为目的的转换疗法可提高晚期或不适合 TACE 的中晚期 HCC 患者的生存率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Oncology 医学-肿瘤学

CiteScore

6.00

自引率

2.90%

发文量

审稿时长

6-12 weeks

期刊介绍： Although laboratory and clinical cancer research need to be closely linked, observations at the basic level often remain removed from medical applications. This journal works to accelerate the translation of experimental results into the clinic, and back again into the laboratory for further investigation. The fundamental purpose of this effort is to advance clinically-relevant knowledge of cancer, and improve the outcome of prevention, diagnosis and treatment of malignant disease. The journal publishes significant clinical studies from cancer programs around the world, along with important translational laboratory findings, mini-reviews (invited and submitted) and in-depth discussions of evolving and controversial topics in the oncology arena. A unique feature of the journal is a new section which focuses on rapid peer-review and subsequent publication of short reports of phase 1 and phase 2 clinical cancer trials, with a goal of insuring that high-quality clinical cancer research quickly enters the public domain, regardless of the trial’s ultimate conclusions regarding efficacy or toxicity.