Combined Stereotactic Body Radiotherapy and Immunotherapy Versus Transarterial Chemoembolization in Locally Advanced Hepatocellular Carcinoma: A Propensity Score Matching Analysis.
Combined Stereotactic Body Radiotherapy and Immunotherapy Versus Transarterial Chemoembolization in Locally Advanced Hepatocellular Carcinoma: A Propensity Score Matching Analysis.
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立体定向全身放射治疗和免疫治疗与经动脉化疗栓塞治疗局部晚期肝细胞癌的联合治疗：倾向评分匹配分析。
DOI：
10.3389/fonc.2021.798832
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发表时间：
2021
影响因子：
4.7
通讯作者：
Chan AC
中科院分区：
文献类型：
--
作者：
Chiang CL;Chiu KW;Lee FA;Kong FS;Chan AC
免疫疗法在HCC患者中取得了适度的临床疗效。倾向评分匹配分析比较了立体定向SBRT-IO联合TACE治疗香港某三级中心局部晚期HCC患者的疗效和安全性。局部晚期HCC患者，医学上不能手术、难治性或拒绝根治性手术干预的患者符合条件。主要结局为PFS；次要结果为OS、mRECIST 1.1版本的ORR和TRAEs。采用配对分析比较临床结果。共有226例患者符合条件。SBRT-IO组中约有16名患者与48名接受TACE治疗的患者配对。肿瘤中位大小为10 cm（范围：2.9 ~ 19.6 cm）， 20.3%的患者有门静脉侵犯。SBRT-IO组12个月和24个月的PFS明显更好（分别为93.3% vs 16.7%和77.8% vs 2.1%, p <0.001）；SBRT-IO组12个月和24个月的OS也更好（分别为93.8%比31.3%和80.4%比8.3%,p <0.001）。SBRT-IO组的ORR为87.5% (CR: 50%, PR: 37.5%)，而单独接受TACE组的ORR为16.7% (CR: 2.4%, PR: 14.3%) （p <0.001）。在SBRT-IO组中，由于不良事件导致的≥3级TRAE （60.4% vs 18.8%, p = 0.004）和治疗中断（25% vs 12.5%, p = 0.295）较少。在局部晚期HCC患者中，SBRT-IO的生存期明显优于TACE，治疗毒性也低于TACE。我们的结果为在前瞻性随机试验中研究这种联合治疗提供了理论依据。
Immunotherapy has achieved modest clinical activity in HCC patients. Propensity score matching analysis was conducted to compare the efficacy and safety of combined stereotactic SBRT-IO versus TACE in patients with locally advanced HCC in a tertiary center of Hong Kong. Patients with locally advanced HCC who were medically inoperable for, refractory to, or refused to curative surgical interventions were eligible. The primary outcome was PFS; the secondary outcomes were OS, ORR as per mRECIST version 1.1, and TRAEs. Matching pair analysis was performed to compare the clinical outcomes. A total of 226 patients were eligible. Approximately 16 patients in the SBRT-IO group were matched with 48 patients treated with TACE. The median tumor size was 10 cm (range: 2.9–19.6 cm) and 20.3% of the patients had portal vein invasion. The 12- and 24-month PFS were significantly better in the SBRT-IO group (93.3% vs 16.7% and 77.8% vs 2.1%, respectively, p <0.001); the 12- and 24-month OS were also better in the SBRT-IO arm (93.8% vs 31.3% and 80.4% vs 8.3%, respectively, p <0.001). The ORR was 87.5% (CR: 50%, PR: 37.5%) in SBRT-IO arm compared to 16.7% (CR: 2.4%, PR: 14.3%) in those receiving TACE alone (p <0.001). There were fewer ≥grade 3 TRAE (60.4% vs 18.8%, p = 0.004) and treatment discontinuations (25% vs 12.5%, p = 0.295) due to adverse events in the SBRT-IO arm. SBRT-IO had significant superior survival and less treatment toxicity than TACE in patients with locally advanced HCC. Our results provide rationale for studying this combination therapy in prospective randomized trials.
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影响因子：
5
作者：
Wang TC;An TZ;Li JX;Zhang ZS;Xiao YD
通讯作者：
Xiao YD
影响因子：
28.4
作者：
Theelen, Willemijn S. M. E.;Peulen, Heike M. U.;Baas, Paul
通讯作者：
Baas, Paul
影响因子：
45.3
作者：
Finn, Richard S.;Ikeda, Masafumi;Llovet, Josep M.
通讯作者：
Llovet, Josep M.
影响因子：
13.5
作者：
Lo, CM;Ngan, H;Wong, J
通讯作者：
Wong, J
影响因子：
158.5
作者：
Finn, Richard S.;Qin, Shukui;Cheng, Ann-Lii
通讯作者：
Cheng, Ann-Lii