外科理论与实践

外科理论与实践 ›› 2022, Vol. 27 ›› Issue (02): 152-157.doi: 10.16139/j.1007-9610.2022.02.013

• 论著 • 上一篇    下一篇

肝细胞癌的抗血管生成免疫联合介入治疗：肝动脉灌注化疗与化疗栓塞疗效的比较

张希昊1a, 章馨允2, 曹曼卿1b, 张金梁1a, 王华琪1a, 张苏1c, 付周1a, 王鲁3, 张倜3()   

  1. 1.天津医科大学肿瘤医院a. 肝胆科,b. 乳腺外科,c. 妇科肿瘤科,国家肿瘤临床医学研究中心,天津市肿瘤防治重点实验室,天津 300060
    2.天津市第三中心医院肿瘤科,天津 300170
    3.复旦大学附属肿瘤医院肝脏外科,上海 200032
  • 收稿日期:2022-03-15 出版日期:2022-05-25 发布日期:2022-06-16
  • 通讯作者: 张倜 E-mail:zhangti@shca.org.cn
  • 基金资助:
    国家自然科学基金(82172632)

Both anti-angiogenesis and immunotherapy combined with interventional therapy in treatment of hepatocellular carcinoma: effect of hepatic artery infusion chemotherapy compared with hepatic artery chemoembolization

ZHANG Xihao1a, ZHANG Xinyun2, CAO Manqing1b, ZHANG Jinliang1a, WANG Huaqi1a, ZHANG Su1c, FU Zhou1a, WANG Lu3, ZHANG Ti3()   

  1. 1. Tianjin Medical University Cancer Institute and Hospital, a. Department of Hepatobiliary Surgery, b. Department of Breast Surgery, c. Department of Gynecologic Oncology, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
    2. Department of Oncology, The Third Central Hospital of Tianjin, Tianjin 300170, China
    3. Department of Hepatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
  • Received:2022-03-15 Online:2022-05-25 Published:2022-06-16
  • Contact: ZHANG Ti E-mail:zhangti@shca.org.cn

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摘要：

目的： 旨在比较抗血管生成免疫治疗联合肝动脉灌注化疗（hepatic artery infusion chemotherapy, HAIC）与联合肝动脉化疗栓塞（transcatheter arterial chemoembolization, TACE）治疗肝细胞癌的有效性和安全性。方法： 回顾性分析天津医科大学肿瘤医院2019年1月至2020年12月收治93例肝细胞癌病人,B期18例,C期75例。男74例,女19例,中位年龄57（27~78）岁。50例行抗血管生成免疫联合TACE（TACE组）治疗,43例行抗血管生成免疫联合HAIC（HAIC组）治疗。采用实体肿瘤疗效评价标准RECIST1.1评估疗效。主要观察终点为客观反应率和疾病控制率,次要观察终点为中位无进展生存期及中位总生存期。结果： HAIC组客观反应率和疾病控制率显著高于TACE组（客观反应率：72.09%比44.00%,P=0.006;疾病控制率：88.37%比60.00%,P=0.002）。 HAIC组及TACE组的中位随访时间分别为12.13个月及11.95个月。截至随访,TACE组中位无进展生存期11.83个月（95%CI：4.36~19.31个月）,中位总生存期17.93个月（95%CI：11.80~24.06个月）,而HAIC组均未到达中位无进展生存期和总生存期。两组无进展生存期及总生存期差异有统计学意义（P=0.017,P=0.007）。结论： 针对进展期肝细胞癌,抗血管生成免疫联合HAIC相比联合TACE在疾病控制和生存上获益更大,不良反应相对可控,安全性好。

关键词: 肝动脉灌注化疗, 肝动脉化疗栓塞, 抗血管生成, 免疫治疗, 肝细胞癌

Abstract:

Objective To compare hepatic artery infusion chemotherapy (HAIC) with transcatheter arterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma combined with both anti-angiogenesis and immunotherapy for effectiveness and safety. Methods Ninety-three patients with hepatocellular carcinoma including stage B 18 cases and stage C 75 cases, and 74 males, 19 females with a median age of 57 (27-78) in Tianjin Medical University Cancer Hospital from January 2019 to December 2020 were studied retrospectively. In the treatment combined with anti-angiogenesis and immunotherapy, 50 cases received TACE and 43 cases received HAIC. Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.1 was used to evaluate the efficacy of treatment. The primary endpoints were both objective response rate (ORR) and disease control rate (DCR), and the secondary endpoints both median progression free survival (mPFS) and median overall survival (mOS). Results Both ORR (72.09% vs. 44.00%, P=0.006) and DCR (88.37% vs. 60.00%, P=0.002) were significantly more in HAIC group than in TACE group. The median follow-up duration was 12.13 months in HAIC group and 11.95 months in TACE group. mPFS in TACE group was 11.83 months (95%CI: 4.36-19.31 months) with mOS 17.93 months (95%CI: 11.80-24.06 months). Both mPFS and mOS did not reach in HAIC group. There were significant differences in PFS and OS between two groups (P=0.017; P=0.007). Conclusions The patients with advanced hepatocellular carcinoma would benefit from HAIC combined with both anti-angiogenesis and immunotherapy in disease control and survival with less side effects and better safety when compared with TACE combination treatment.

Key words: Hepatic artery infusion chemotherapy (HAIC), Hepatic transcatheter arterial chemoembolization (TACE), Anti-angiogenesis therapy, Immunotherapy, Hepatocellular carcinoma (HCC)

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