Louisa Stern , Constantin Schmidt , Lorenz Kocheise , Vincent Joerg , Christian Casar , Aurélie Walter , Joost P.H. Drenth , Maria Papp , Nikolaos K. Gatselis , Kalliopi Zachou , Matthias Pinter , Bernhard Scheiner , Arndt Vogel , Martha M. Kirstein , Fabian Finkelmeier , Oliver Waidmann , Arndt Weinmann , Piotr Milkiewicz , Douglas Thorburn , Neil Halliday , Kornelius Schulze
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引用次数: 0
Abstract
Introduction and Objectives
Autoimmune liver diseases (AILD) are rare causes hepatocellular carcinoma (HCC), and data on the efficacy and tolerability of anti-tumor therapies are scarce. This pan-European study aimed to assess outcomes in AILD-HCC patients treated with tyrosine kinase inhibitors (TKIs) or transarterial chemoembolization (TACE) compared with patients with more common HCC etiologies, including viral, alcoholic or non-alcoholic fatty liver disease.
Materials and Methods
107 patients with HCC-AILD (AIH:55; PBC:52) treated at 13 European centres between 1996 and 2020 were included. 65 received TACE and 28 received TKI therapy. 43 (66 %) were female (median age 73 years) with HCC tumor stage BCLC A (34 %), B (46 %), C (9 %) or D (11 %). For each treatment type, propensity score matching was used to match AILD to non-AILD-HCC on a 1:1 basis, yielding in a final cohort of 130 TACE and 56 TKI patients for comparative analyses of median overall survival (mOS) and treatment tolerability.
Results
HCC-AILD patients showed comparable mOS to controls for both TACE (19.5 vs. 22.1 months, p = 0.9) and TKI (15.4 vs. 15.1 months, p = 0.5). Adverse events were less frequent in AILD-HCC patients than controls (33 % % vs. 62 %, p = 0.003). For TKIs, there were no significant differences in adverse events (73% vs. 86%, p = 0.2) or interruption rates (44% vs. 36 %, p = 0.7).
Conclusions
In summary, this study demonstrates comparable mOS for AILD-HCC patients undergoing local and systemic treatments, with better tolerability than HCC of other causes. TKIs remain important therapeutic options for AILD-HCC patients, particularly given their exclusion from recent immunotherapy trials.
导言和目标:自身免疫性肝病(AILD)是肝细胞癌(HCC)的罕见病因,有关抗肿瘤疗法的疗效和耐受性的数据很少。这项泛欧研究旨在评估接受酪氨酸激酶抑制剂(TKIs)或经动脉化疗栓塞(TACE)治疗的AILD-HCC患者与更常见的HCC病因(包括病毒性、酒精性或非酒精性脂肪肝)患者相比的疗效。65例接受了TACE治疗,28例接受了TKI治疗。43人(66%)为女性(中位年龄为73岁),HCC肿瘤分期为BCLC A(34%)、B(46%)、C(9%)或D(11%)。对于每种治疗类型,均采用倾向评分匹配法将AILD与非AILD-HCC按1:1进行匹配,最终得出130例TACE和56例TKI患者,用于中位总生存期(mOS)和治疗耐受性的比较分析:结果:HCC-AILD患者的TACE(19.5个月 vs 22.1个月,P=0.9)和TKI(15.4个月 vs 15.1个月,P=0.5)中位总生存期与对照组相当。AILD-HCC患者的不良事件发生率低于对照组(33% vs 62%,P=0.003)。对于 TKIs,不良事件(73% vs. 86%,p=0.2)或中断率(44% vs. 36%,p=0.7)没有显著差异:总之,这项研究表明,接受局部和全身治疗的AILD-HCC患者的mOS值相当,耐受性优于其他原因导致的HCC。TKIs仍然是AILD-HCC患者的重要治疗选择,尤其是考虑到近期的免疫疗法试验中没有TKIs。
期刊介绍:
Annals of Hepatology publishes original research on the biology and diseases of the liver in both humans and experimental models. Contributions may be submitted as regular articles. The journal also publishes concise reviews of both basic and clinical topics.