Hepatic arterial infusion chemotherapy combined with lenvatinib and immune checkpoint inhibitor versus lenvatinib for advanced hepatocellular carcinoma: a multicenter study with propensity score and coarsened exact matching.
IF 9.7 1区 医学Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
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引用次数: 0
Abstract
Purpose: Hepatic arterial infusion chemotherapy (HAIC) combined with lenvatinib (Len) and immune checkpoint inhibitor (ICI) in treating advanced hepatocellular carcinoma (HCC) still needs further confirmation. We aimed to evaluate the efficacy of HAIC combined with Len and ICI (HAIC + Len + ICI) versus Len alone in advanced HCC.
Methods: A total of 290 patients in Len group and 349 patients in HAIC + Len + ICI group were analysed. Propensity score matching (PSM), inverse probability treatment weighting (IPTW), and coarsened exact matching (CEM) analyses were used to balance the bias between two groups. Mediation analysis of treatment type in survival was performed for analysis.
Results: The median progression-free survival (PFS) was 5.9 ± 0.2 months in Len group and 9.2 ± 0.5 months in HAIC + Len + ICI group. The HAIC + Len + ICI group demonstrated significantly better PFS than the Len group across the entire cohort (hazard ratio [HR], 0.50; 95% CI 0.43-0.60; P < 0.001). This advantage in PFS was sustained in the PSM, IPTW, and CEM cohorts. HAIC + Len + ICI group also showed better overall survival (OS) than the Len group (HR, 0.38; 95% CI 0.31-0.46; P < 0.001). The OS was also superior in the PSM, IPTW, and CEM cohorts. The objective response rate (ORR) in HAIC + Len + ICI group was twice as high as that in Len group. Further mediation analysis showed tumor response at 3 and 6 months had different mediation effect on survival.
Conclusions: HAIC combined with Len and ICI showed improved better OS and PFS than Len alone. This triple therapy could be considered as a first-line treatment for advanced HCC.
目的：肝动脉灌注化疗（HAIC）联合lenvatinib （Len）和免疫检查点抑制剂（ICI）治疗晚期肝细胞癌（HCC）仍需进一步证实。我们的目的是评估HAIC联合Len和ICI （HAIC + Len + ICI）与Len单独治疗晚期HCC的疗效。方法：对Len组290例患者和HAIC + Len + ICI组349例患者进行分析。采用倾向评分匹配（PSM）、逆概率处理加权（IPTW）和粗化精确匹配（CEM）分析来平衡两组间的偏倚。对治疗方式对生存率的影响进行中介分析。结果：Len组的中位无进展生存期（PFS）为5.9±0.2个月，HAIC + Len + ICI组为9.2±0.5个月。在整个队列中，HAIC + Len + ICI组的PFS明显优于Len组(风险比[HR]， 0.50；95% ci 0.43-0.60；结论：HAIC联合Len和ICI的OS和PFS均优于Len单用。这种三联疗法可以被认为是晚期HCC的一线治疗。
期刊介绍：
Felice Perussia founded La radiologia medica in 1914. It is a peer-reviewed journal and serves as the official journal of the Italian Society of Medical and Interventional Radiology (SIRM). The primary purpose of the journal is to disseminate information related to Radiology, especially advancements in diagnostic imaging and related disciplines. La radiologia medica welcomes original research on both fundamental and clinical aspects of modern radiology, with a particular focus on diagnostic and interventional imaging techniques. It also covers topics such as radiotherapy, nuclear medicine, radiobiology, health physics, and artificial intelligence in the context of clinical implications. The journal includes various types of contributions such as original articles, review articles, editorials, short reports, and letters to the editor. With an esteemed Editorial Board and a selection of insightful reports, the journal is an indispensable resource for radiologists and professionals in related fields. Ultimately, La radiologia medica aims to serve as a platform for international collaboration and knowledge sharing within the radiological community.
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