Evaluating the impact of treatment sequencing on outcomes in hepatocellular carcinoma: a comparative analysis of TACE and systemic therapies.

IF 3.2 4区 医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL
XingRong Zheng, Xin Song, BoXiang Zhang, XiYao Chen, YeQiong Zhang, QiuMin Luo, ZhiPeng Li, ZheXuan Deng, RuiXuan Xu, Liang Peng, Chan Xie
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Abstract

This study aimed to evaluate how the timing of transarterial chemoembolization (TACE) relative to systemic therapy (tyrosine-kinase inhibitors [TKIs] and immune checkpoint inhibitors [ICIs]) influences oncological outcomes in patients with hepatocellular carcinoma (HCC). A retrospective analysis was conducted on HCC patients treated with TACE plus TKIs and ICIs from January 2018 to February 2023. We compared objective response rate (ORR), disease control rate (DCR), overall survival (OS), and progression-free survival (PFS) between patients receiving TACE before versus after systemic therapies. Multivariate Cox regression analyses identified potential prognostic factors. Of the 194 patients enrolled, 111 received TACE before systemic therapies, and 83 after. The median age at diagnosis was 52.8 years. There were no significant differences in ORR (40.72% vs. 30.41%, p = 0.989) or DCR (48.45% vs. 35.57%, p = 0.770) between the groups. Likewise, OS (18.73 vs. 18.20 months, p = 0.091) and PFS (11.53 vs. 10.05 months, p = 0.336) were similar regardless of treatment sequence. In the result of Cox analysis, a 20% decrease in AFP from baseline at one month was associated with improved OS (HR = 0.35, 95% CI 0.17-0.70, p = 0.003) and PFS (HR = 0.69, 95% CI 0.49-0.96, p = 0.028). Large tumor size (≥ 10 cm) was a poor prognostic factor for OS (HR = 2.12, 95% CI 1.07-4.21, p = 0.032), and the presence of portal vein tumor thrombus adversely affected PFS (HR = 2.31, 95% CI 1.47-3.62, p < 0.001). The sequencing of TACE and systemic therapies does not significantly impact the prognosis of advanced HCC. A 20% reduction in AFP within one month of treatment commencement emerges as a protective prognostic factor for HCC.

评估治疗顺序对肝细胞癌预后的影响:TACE 和系统疗法的比较分析。
本研究旨在评估经动脉化疗栓塞(TACE)与全身治疗(酪氨酸激酶抑制剂[TKIs]和免疫检查点抑制剂[ICIs])的时机如何影响肝细胞癌(HCC)患者的肿瘤预后。我们对2018年1月至2023年2月期间接受TACE加TKIs和ICIs治疗的HCC患者进行了回顾性分析。我们比较了接受 TACE 之前和接受系统疗法之后患者的客观反应率(ORR)、疾病控制率(DCR)、总生存期(OS)和无进展生存期(PFS)。多变量考克斯回归分析确定了潜在的预后因素。在194名入选患者中,111人在接受系统疗法之前接受了TACE,83人在接受系统疗法之后接受了TACE。诊断时的中位年龄为52.8岁。两组患者的 ORR(40.72% 对 30.41%,P = 0.989)或 DCR(48.45% 对 35.57%,P = 0.770)无明显差异。同样,无论治疗顺序如何,OS(18.73 个月 vs. 18.20 个月,p = 0.091)和 PFS(11.53 个月 vs. 10.05 个月,p = 0.336)均相似。Cox分析结果显示,一个月后AFP比基线下降20%与OS(HR = 0.35,95% CI 0.17-0.70,p = 0.003)和PFS(HR = 0.69,95% CI 0.49-0.96,p = 0.028)的改善相关。肿瘤体积较大(≥ 10 cm)是OS(HR = 2.12,95% CI 1.07-4.21,p = 0.032)的不良预后因素,门静脉肿瘤血栓的存在对PFS有不利影响(HR = 2.31,95% CI 1.47-3.62,p = 0.032)。
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
Clinical and Experimental Medicine
Clinical and Experimental Medicine 医学-医学:研究与实验
CiteScore
4.80
自引率
2.20%
发文量
159
审稿时长
2.5 months
期刊介绍: Clinical and Experimental Medicine (CEM) is a multidisciplinary journal that aims to be a forum of scientific excellence and information exchange in relation to the basic and clinical features of the following fields: hematology, onco-hematology, oncology, virology, immunology, and rheumatology. The journal publishes reviews and editorials, experimental and preclinical studies, translational research, prospectively designed clinical trials, and epidemiological studies. Papers containing new clinical or experimental data that are likely to contribute to changes in clinical practice or the way in which a disease is thought about will be given priority due to their immediate importance. Case reports will be accepted on an exceptional basis only, and their submission is discouraged. The major criteria for publication are clarity, scientific soundness, and advances in knowledge. In compliance with the overwhelmingly prevailing request by the international scientific community, and with respect for eco-compatibility issues, CEM is now published exclusively online.
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