摘要
目的探讨经肝动脉化疗栓塞术(TACE)联合抗血管生成药(TKI)的基础上后续使用程序性死亡受体1(PD-1)抑制剂与TACE+TKI两种方式治疗中晚期肝细胞癌(HCC)的有效性、安全性和预后影响因素。方法选取2018年6月—2021年7月在空军军医大学第一附属医院所有接受TACE+TKI+PD-1抑制剂和部分接受TACE+TKI治疗的患者。收集患者的临床资料,采用倾向性评分匹配法平衡组间基线特征。计数资料2组间比较采用χ^(2)检验,TACE次数2组间比较采用Wilcoxon秩和检验,Kaplan-Meier法分析患者的总生存期,单因素和多因素Cox回归模型分析相关预后影响因素。结果共筛选到181例中晚期HCC患者,其中TACE+TKI+PD-1抑制剂治疗的患者为50例,倾向性评分匹配后,纳入40例TACE+TKI+PD-1抑制剂治疗患者(观察组)和40例TACE+TKI治疗患者(对照组)。至随访截止时间,中位随访时间为28.6个月(95%CI:22.1~35.1),观察组的中位生存期为15.9个月(95%CI:7.5~24.2),对照组中位生存期为11.2个月(95%CI:5.0~17.5)。Cox回归分析提示PD-1抑制剂的应用(HR=0.42,95%CI:0.23~0.80,P=0.008)、TACE次数(HR=0.67,95%CI:0.46~0.99,P=0.043)、Child-Pugh分级(HR=2.40,95%CI:1.15~5.00,P=0.019)和血管侵犯(HR=3.42,95%CI:1.11~9.42,P=0.031)是患者预后的独立影响因素。观察组与对照组的2级以上不良反应发生率均为40%,未见显著性差异(P=0.818)。结论TACE+TKI+PD-1抑制剂较TACE+TKI治疗中晚期HCC患者可以明显延长患者生存期,且不良反应相对可控。
Objective To investigate the efficacy and safety of programmed death receptor-1(PD-1)inhibitor combined with transarterial chemoembolization(TACE)and anti-angiogenic drug tyrosine kinase inhibitor(TKI)versus TACE combined with TKI in the treatment of advanced hepatocellular carcinoma(HCC)and related influencing factors for prognosis.Methods An analysis was performed for all patients who received TACE+TKI+PD-1 inhibitor and some patients who received TACE+TKI in The First Affiliated Hospital of Air Force Medical University from June 2018 to July 2021.Related clinical data were collected,and propensity score matching(PSM)was used to balance the baseline characteristics between groups.The chi-square test was used for comparison of categorical data between two groups;the Wilcoxon rank-sum test was used for comparison of the number of TACE procedures between two groups;the Kaplan-Meier method was used to analyze overall survival(OS),and univariate and multivariate Cox regression models were used to analyze the influencing factors for prognosis.Results A total of 181 patients with advanced HCC were screened out,among whom 50 patients were treated with TACE+TKI+PD-1 inhibitor;after PSM,40 patients treated with TACE+TKI+PD-1 inhibitor were enrolled as observation group and 40 patients treated with TACE+TKI were enrolled as control group.At the end of follow-up,the median follow-up time was 28.6(95%confidence interval[CI]:22.1-35.1)months,and the median OS was 15.9(95%CI:7.5-24.2)months in the observation group and 11.2(95%CI:5.0-17.5)months in the control group.The Cox regression analysis showed that the application of PD-1 inhibitor(hazard ratio[HR]=0.42,95%CI:0.23-0.80,P=0.008),the number of TACE procedures(HR=0.67,95%CI:0.46-0.99,P=0.043),Child-Pugh class(HR=2.40,95%CI:1.15-5.00,P=0.019),and vascular invasion(HR=3.42,95%CI:1.11-9.42,P=0.031)were independent influencing factors for prognosis.The incidence rate of grade>2 adverse events was 40%for both the observation group and the control group,and there was no signifi
作者
丁晓鹏
帖君
余嘉豪
任鹏伟
宣国云
马硕怡
郭长存
韩英
周新民
DING Xiaopeng;TIE Jun;YU Jiahao;REN Pengwei;XUAN Guoyun;MA Shuoyi;GUO Changcun;HAN Ying;ZHOU Xinmin(Department of Gastroenterology,The First Affiliated Hospital of Air Force Medical University,Xi’an 710032,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2022年第5期1086-1091,共6页
Journal of Clinical Hepatology
基金
国家自然科学基金面上项目(81870421)。
关键词
癌
肝细胞
化学栓塞
治疗性
程序性细胞死亡受体1
治疗结果
Carcinoma,Hepatocellular
Chemoembolization,Therapeutic
Programmed Cell Death 1 Receptor
Treatment Outcome
