Transarterial chemoembolization plus lenvatinib with or without protein-1 inhibitor for hepatocellular carcinoma with portal vein tumor thrombus.

IF 3.2 Q3 ONCOLOGY

World journal of clinical oncology Pub Date : 2025-06-24 DOI:10.5306/wjco.v16.i6.106798

Shuai Liu, Yao-Hui Liu, Hong-Bo Ni, Jia-Jian Li, Ze-Tao Wu, Luo-Luo Wang, Yi Ruan, Xin-Hua Zhou

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引用次数: 0

Abstract

Background: Hepatocellular carcinoma with portal vein tumor thrombus (HCC-PVTT) is a severe condition with poor prognosis. While transarterial chemoembolization (TACE) combined with lenvatinib (TACE-L) shows some promise, survival outcomes remain suboptimal. We hypothesize that TACE-L plus programmed cell death protein-1 inhibitors (TACE-L-P) may offer superior survival benefits compared to TACE-L in this patient population.

Aim: To compare efficacy and safety of TACE-L-P vs TACE-L in HCC-PVTT and identify prognostic factors.

Methods: Data from HCC-PVTT patients treated with TACE-L-P or TTACE-L from January 2018 to December 2023 were collected and retrospectively analyzed. Propensity score matching (PSM) method with optimal matching was used to minimize confounding bias. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and treatment-related adverse events (AEs) were compared between the two groups. Independent prognostic factors for OS and PFS were elucidated using the Cox proportional hazards model.

Results: A total of 100 patients were included, with 42 patients in the TACE-L-P group and 68 patients in the TACE-L group. After PSM performing optimal matching, baseline characteristics were well balanced between the two groups, each comprising 42 patients. The median OS was significantly longer in the TACE-L-P group compared to the TACE-L group (17.2 months vs 12.6 months, P = 0.0207), as was the median PFS (10.6 months vs 7.1 months, P = 0.012). The ORR and disease control rate were both superior in the TACE-L-P group compared to the TACE-L group (66.7% vs 42.9%, P = 0.049; 78.6% vs 50.0%, P = 0.012). Multivariate analysis revealed that the independent prognostic factors for both OS and PFS were the treatment regimen and extrahepatic metastasis. The incidence of any-grade and grade 3 AEs was comparable between the TACE-L-P and TACE-L groups (84.5% vs 88.1%, P = 0.546), with no occurrences of grade 4/5 AEs or treatment-related mortality in either group.

Conclusion: Compared to TACE-L, the TACE-L-P regimen exhibits an acceptable safety profile and shows potential in improving survival outcomes, making it a promising therapeutic option for patients with HCC-PVTT.

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经动脉化疗栓塞加lenvatinib加或不加蛋白-1抑制剂治疗肝癌合并门静脉肿瘤血栓。

背景：肝细胞癌合并门静脉肿瘤血栓（HCC-PVTT）是一种严重且预后差的疾病。虽然经动脉化疗栓塞（TACE）联合lenvatinib （TACE- l）显示出一些希望，但生存结果仍然不理想。我们假设在该患者群体中，与TACE-L相比，TACE-L加程序性细胞死亡蛋白-1抑制剂（TACE-L- p）可能提供更好的生存益处。目的：比较TACE-L- p与TACE-L治疗HCC-PVTT的疗效和安全性，并探讨影响预后的因素。方法：收集2018年1月至2023年12月接受TACE-L-P或tace - l治疗的HCC-PVTT患者的资料并进行回顾性分析。采用最优匹配的倾向得分匹配（PSM）方法来最小化混杂偏差。比较两组患者的总生存期（OS）、无进展生存期（PFS）、客观缓解率（ORR）和治疗相关不良事件（ae）。使用Cox比例风险模型阐明OS和PFS的独立预后因素。结果：共纳入100例患者，其中TACE-L- p组42例，TACE-L组68例。在PSM进行最佳匹配后，两组的基线特征很好地平衡，每组包括42例患者。与TACE-L-P组相比，TACE-L-P组的中位OS明显更长（17.2个月vs 12.6个月，P = 0.0207），中位PFS也更长（10.6个月vs 7.1个月，P = 0.012）。TACE-L-P组的ORR和疾病控制率均优于TACE-L组(66.7% vs 42.9%, P = 0.049；78.6% vs 50.0%, P = 0.012)。多因素分析显示，OS和PFS的独立预后因素均为治疗方案和肝外转移。TACE-L-P组和TACE-L组之间任何级别和3级ae的发生率相当（84.5% vs 88.1%, P = 0.546），两组均未发生4/5级ae或治疗相关死亡率。结论：与TACE-L方案相比，TACE-L- p方案具有可接受的安全性，并显示出改善生存结果的潜力，使其成为HCC-PVTT患者的有希望的治疗选择。

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

World journal of clinical oncology ONCOLOGY-

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发文量

585

期刊介绍： The WJCO is a high-quality, peer reviewed, open-access journal. The primary task of WJCO is to rapidly publish high-quality original articles, reviews, editorials, and case reports in the field of oncology. In order to promote productive academic communication, the peer review process for the WJCO is transparent; to this end, all published manuscripts are accompanied by the anonymized reviewers’ comments as well as the authors’ responses. The primary aims of the WJCO are to improve diagnostic, therapeutic and preventive modalities and the skills of clinicians and to guide clinical practice in oncology. Scope: Art of Oncology, Biology of Neoplasia, Breast Cancer, Cancer Prevention and Control, Cancer-Related Complications, Diagnosis in Oncology, Gastrointestinal Cancer, Genetic Testing For Cancer, Gynecologic Cancer, Head and Neck Cancer, Hematologic Malignancy, Lung Cancer, Melanoma, Molecular Oncology, Neurooncology, Palliative and Supportive Care, Pediatric Oncology, Surgical Oncology, Translational Oncology, and Urologic Oncology.