肝动脉灌注化疗联合靶免治疗对合并门静脉癌栓的大肝癌短期效果分析OA
Short-term efficacy of hepatic arterial infusion chemotherapy combined with targeted-immune therapy in patients with large hepatocellular carcinoma complicated by portal vein tumor thrombus
目的 探讨肝动脉灌注化疗(HAIC)联合靶免治疗对比单纯靶免治疗对合并门静脉癌栓(PVTT)的大肝癌有效性及安全性.方法 回顾性研究2022年1月至2023年4月温州医科大学附属第二医院介入医学科收治的63例合并PVTT的大肝癌患者,观察组接受HAIC联合仑伐替尼及替雷利珠单抗的介入联合靶免治疗(n=33),对照组接受仑伐替尼及替雷利珠单抗的靶免治疗(n=30).比较两组患者的客观缓解率(ORR)、疾病控制率(DCR)、疾病无进展生存(PFS)和总生存(OS)情况,以及治疗相关的不良事件发生率.结果 在治疗有效性方面,观察组患者ORR(78.8%vs 46.7%,χ2=6.995,P=0.008)和DCR(90.9%vs 66.7%,χ2=5.639,P=0.018)均明显高于对照组.在生存期方面,观察组mPFS[mPFS时间:95%CI(5.13-6.87)个月 vs 95%CI(3.12-4.88)个月;6个月的PFS率:43.5%vs 29.6%,χ2=7.341,P=0.007]和mOS[mOS时间:95%CI(10.86-17.13)个月 vs 95%CI(7.99-12.10)个月;12个月的累积OS率:53.6%vs 30.0%,χ2=8.521,P=0.004]均显著优于对照组.安全性方面,观察组粒细胞和血小板减少的发生率显著高于对照组(42.4%vs 10.1%,χ2=8.385,P=0.004),但其他不良事件发生率的两组比较差异均无统计学意义(P>0.05).结论 针对合并PVTT的大肝癌,HAIC联合靶免治疗相较于单纯靶免治疗可显著提高患者的短期ORR和DCR,同时可延长患者的PFS和OS;该联合治疗方案安全性可控.
Objective To investigate the short-term efficacy and safety of hepatic arterial infusion chemotherapy(HAIC)combined with targeted-immune therapy versus targeted-immune therapy alone in patients with large hepatocellular carcinoma(HCC)complicated by portal vein tumor thrombus(PVTT).Methods A retrospective study was conducted on 63 patients with large HCC and PVTT,who were admitted to the Second Affiliated Hospital of Wenzhou Medical University between January 2022 and April 2023.Thirty-three patients in the observation group received HAIC plus lenvatinib and tislelizumab(interventional-combined targeted-immune therapy),while 30 patients in the control group received lenvatinib and tislelizumab alone(targeted-immune therapy).The primary outcomes included objective response rate(ORR),disease control rate(DCR),progression-free survival(PFS),overall survival(OS),and incidence of treatment-related adverse events.Results In terms of treatment efficacy,the observation group demonstrated significantly higher ORR(78.8%vs 46.7%,χ2=6.995,P=0.008)and DCR(90.9%vs 66.7%,χ2=5.639,P=0.018)compared with the control group.Regarding survival outcome,the median PFS was significantly longer in the observation group[95%CI(5.13 to 6.87)months vs 95%CI(3.12 to 4.88)months],the PFS rate at 6 months after treatment was higher in the observation group(43.5%vs 29.6%,χ2=7.341,P=0.007).Similarly,the median OS was significantly improved in the observation group[95%CI(10.86 to 17.13)months vs 95%CI(7.99 to 12.01)months],the cumulative OS rate at 12 months after treatment was higher in the observation group(53.6%vs 30.0%,χ2=8.521,P=0.004).In terms of safety,the observation group had a significantly higher incidence of neutropenia and thrombocytopenia(42.4%vs 10.1%,χ2=8.385,P=0.004).However,no statistically significant difference was observed in other treatment-related adverse events between the two groups(P>0.05).Conclusion For patients with large HCC and PVTT,HAIC combined with targeted-immune therapy may significantly improve the short-term ORR and DCR,prolong both PFS and OS,and exhibit a manageable safety profile compared with targeted-immune therapy alone.This combination represents a promising therapeutic strategy for patients with large HCC and PVTT.
张东;姚红响;王兆洪;杨琰
温州医科大学附属第二医院 介入医学科,浙江 温州 325000温州医科大学附属第二医院 介入医学科,浙江 温州 325000温州医科大学附属第二医院 肝胆胰外科,浙江 温州 325000温州医科大学附属第二医院 超声影像科,浙江 温州 325000
医药卫生
肝细胞癌门静脉癌栓大肝癌肝动脉灌注化疗靶免治疗仑伐替尼替雷利珠单抗
hepatocellular carcinomaportal vein tumor thrombuslarge hepatocellular carcinomahepatic arterial infusion chemotherapytargeted-immune therapylenvatinibtislelizumab
《肝胆胰外科杂志》 2026 (2)
103-109,7
温州市科技局基础性医疗卫生科技项目(Y20211054).
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