PDF(Pubmed)
Abstract：
UNASSIGNED: The preoperative conversion therapy for advanced hepatocellular carcinoma (HCC) is still being explored. This study reported the potential of combination of transarterial chemoembolization (TACE), hepatic arterial infusion chemotherapy (HAIC), programmed cell death protein-1 (PD-1) inhibitors and lenvatinib as preoperative conversion therapy for nonmetastatic advanced HCC.
UNASSIGNED: This retrospective study gathered data on patients with nonmetastatic advanced HCC who received this combination therapy. We used drug-eluting bead (DEB) instead of conventional iodized oil in TACE. The clinical data, conversion rate, adverse events (AEs) and short-term survival were summarized. A stratified analysis based on whether or not the patient received surgery was conducted.
UNASSIGNED: A total of 28 patients were included in the analysis. No grade 4 AEs were observed. The overall objective response rate (ORR) was 64.3%. Ten (35.7%) patients eventually received R0 resection after 2 cycles of combination therapy. Patients succeeding to resection (surgery group) had significantly higher ORR (90.0% vs. 50.0%, P=0.048). The proportion of patients with alpha-fetoprotein (AFP) >1,000 µg/L was significantly lower in surgery group (10.0% vs. 66.7%, P=0.006). After combination therapy, more patients in surgery group experienced significant reduction of >90% in AFP levels (75.0% vs. 23.1%, P=0.03), as well as standardized uptake value (SUV) of 18F-fluorodeoxyglucose (18F-FDG) both in primary tumors and portal vein tumor thrombosis (PVTT) (60.0% vs. 5.6%, P=0.003; 57.1% vs. 8.3%, P=0.04). Of note, 85.7% of PVTT exhibited major pathological response (MPR) in pathological examination although only 28.6% achieved downstage in preoperative imaging examination. MPR was more commonly observed in PVTT than in main tumors (85.7% vs. 20.0%). In non-surgery group, the median overall survival (OS) was 7 months with a 1-year survival rate of 27.8%, while in surgery group, the median OS was not reached and 1-year survival rate was 60.0%.
UNASSIGNED: The combination of TACE-HAIC, PD-1 inhibitors and lenvatinib showed its benefit as a preoperative conversion therapy for nonmetastatic advanced HCC. In addition to imaging evaluation, significant reduction of 18F-FDG uptake and AFP can be used as predictors of successful conversion, especially for PVTT.
UNASSIGNED: This retrospective study gathered data on patients with nonmetastatic advanced HCC who received this combination therapy. We used drug-eluting bead (DEB) instead of conventional iodized oil in TACE. The clinical data, conversion rate, adverse events (AEs) and short-term survival were summarized. A stratified analysis based on whether or not the patient received surgery was conducted.
UNASSIGNED: A total of 28 patients were included in the analysis. No grade 4 AEs were observed. The overall objective response rate (ORR) was 64.3%. Ten (35.7%) patients eventually received R0 resection after 2 cycles of combination therapy. Patients succeeding to resection (surgery group) had significantly higher ORR (90.0% vs. 50.0%, P=0.048). The proportion of patients with alpha-fetoprotein (AFP) >1,000 µg/L was significantly lower in surgery group (10.0% vs. 66.7%, P=0.006). After combination therapy, more patients in surgery group experienced significant reduction of >90% in AFP levels (75.0% vs. 23.1%, P=0.03), as well as standardized uptake value (SUV) of 18F-fluorodeoxyglucose (18F-FDG) both in primary tumors and portal vein tumor thrombosis (PVTT) (60.0% vs. 5.6%, P=0.003; 57.1% vs. 8.3%, P=0.04). Of note, 85.7% of PVTT exhibited major pathological response (MPR) in pathological examination although only 28.6% achieved downstage in preoperative imaging examination. MPR was more commonly observed in PVTT than in main tumors (85.7% vs. 20.0%). In non-surgery group, the median overall survival (OS) was 7 months with a 1-year survival rate of 27.8%, while in surgery group, the median OS was not reached and 1-year survival rate was 60.0%.
UNASSIGNED: The combination of TACE-HAIC, PD-1 inhibitors and lenvatinib showed its benefit as a preoperative conversion therapy for nonmetastatic advanced HCC. In addition to imaging evaluation, significant reduction of 18F-FDG uptake and AFP can be used as predictors of successful conversion, especially for PVTT.
摘要：
■晚期肝细胞癌（HCC）的术前转化治疗仍在探索中。这项研究报道了联合经肝动脉化疗栓塞（TACE）的潜力，肝动脉灌注化疗（HAIC），程序性细胞死亡蛋白-1（PD-1）抑制剂和乐伐替尼作为非转移性晚期HCC的术前转换治疗。
■这项回顾性研究收集了接受这种联合治疗的非转移性晚期HCC患者的数据。我们在TACE中使用药物洗脱珠（DEB）代替常规碘化油。临床数据,转化率，对不良事件(AE)和短期生存率进行了总结.根据患者是否接受手术进行分层分析。
■共28例患者纳入分析。没有观察到4级AE。总客观有效率(ORR)为64.3%。10例（35.7％）患者在2个周期的联合治疗后最终接受了R0切除。成功切除的患者（手术组）的ORR明显较高（90.0％vs.50.0%,P=0.048)。手术组中甲胎蛋白（AFP）>1,000µg/L的患者比例显着降低（10.0％vs.66.7%,P=0.006)。联合治疗后,更多的手术组患者AFP水平显着降低>90%(75.0%vs.23.1%,P=0.03),以及原发性肿瘤和门静脉肿瘤血栓形成（PVTT）中18F-氟脱氧葡萄糖（18F-FDG）的标准化摄取值（SUV）（60.0％vs.5.6%,P=0.003;57.1%vs.8.3%,P=0.04)。值得注意的是，85.7％的PVTT在病理检查中表现出主要病理反应（MPR），尽管在术前影像学检查中只有28.6％达到了下降阶段。MPR在PVTT中比在主要肿瘤中更常见（85.7％vs.20.0%）。在非手术组中，中位总生存期（OS）为7个月，1年生存率为27.8%，在手术组，中位OS未达到,1年生存率为60.0%.
■TACE-HAIC的组合，PD-1抑制剂和lenvatinib显示出其作为非转移性晚期HCC的术前转换治疗的益处。除了影像学评估，18F-FDG摄取和AFP的显着减少可以用作成功转化的预测因子，尤其是PVTT。
■这项回顾性研究收集了接受这种联合治疗的非转移性晚期HCC患者的数据。我们在TACE中使用药物洗脱珠（DEB）代替常规碘化油。临床数据,转化率，对不良事件(AE)和短期生存率进行了总结.根据患者是否接受手术进行分层分析。
■共28例患者纳入分析。没有观察到4级AE。总客观有效率(ORR)为64.3%。10例（35.7％）患者在2个周期的联合治疗后最终接受了R0切除。成功切除的患者（手术组）的ORR明显较高（90.0％vs.50.0%,P=0.048)。手术组中甲胎蛋白（AFP）>1,000µg/L的患者比例显着降低（10.0％vs.66.7%,P=0.006)。联合治疗后,更多的手术组患者AFP水平显着降低>90%(75.0%vs.23.1%,P=0.03),以及原发性肿瘤和门静脉肿瘤血栓形成（PVTT）中18F-氟脱氧葡萄糖（18F-FDG）的标准化摄取值（SUV）（60.0％vs.5.6%,P=0.003;57.1%vs.8.3%,P=0.04)。值得注意的是，85.7％的PVTT在病理检查中表现出主要病理反应（MPR），尽管在术前影像学检查中只有28.6％达到了下降阶段。MPR在PVTT中比在主要肿瘤中更常见（85.7％vs.20.0%）。在非手术组中，中位总生存期（OS）为7个月，1年生存率为27.8%，在手术组，中位OS未达到,1年生存率为60.0%.
■TACE-HAIC的组合，PD-1抑制剂和lenvatinib显示出其作为非转移性晚期HCC的术前转换治疗的益处。除了影像学评估，18F-FDG摄取和AFP的显着减少可以用作成功转化的预测因子，尤其是PVTT。
