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.
■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。