TACE联合阿帕替尼对比单独TACE治疗中晚期原发性肝癌的倾向性匹配分析

TACE combined with apatinib versus TACE alone for middle-stage and advanced hepatocellular carcinoma:a propensity matching analysis

目的运用倾向性得分匹配法评估TACE联合阿帕替尼与单纯TACE治疗中晚期原发性肝癌的疗效。方法回顾性分析2016年6月至2017年12月收治的265例中晚期原发性肝癌临床资料。根据入选标准,纳入115例具有完整临床资料的中晚期肝癌患者;按治疗方法分为两组,TACE联合阿帕替尼(联合组)患者29例,单纯TACE患者86例(对照组);利用倾向性得分匹配,按1∶1进行配对后分析两种治疗方式的临床效果。主要观察两组的生存期(OS)及无进展生存期(PFS),次要观察两组治疗后的肿瘤应答及阿帕替尼相关不良反应。结果实际匹配25对,配对后组间基线资料具有可比性。匹配后,TACE联合阿帕替尼组的1、2和3年生存率分别为68%、32%和8%,明显优于单纯TACE组的44%、20%和0%(P=0.046)。匹配前联合组mOS及mPFS分别为19个月和14个月,对照组分别为12个月和4个月(P<0.05)。匹配后联合组mOS及mPFS分别为18个月和10个月,对照组为9个月和5个月(P<0.05)。联合组对肿瘤应答具有更好的反应率和疾病控制率,且联合组未出现严重不良反应。结论TACE联合阿帕替尼治疗中晚期肝癌可显著延长患者OS和PFS,且较对照组明显提高肿瘤应答率及控制率。

Objective To compare the curative effect of transcatheter arterial chemoembolization(TACE)plus apatinib with that of TACE alone for middle-stage and advanced hepatocellular carcinoma(HCC)by using propensity score matching method.Methods The clinical data of 265 patients with middlestage and advanced HCC,who were admitted to authors’hospital to receive treatment during the period from June 2016 to December 2017,were retrospectively analyzed.Based on the inclusion criteria,a total of 115 patients who had complete clinical data were enrolled in this study.According to the therapeutic scheme,the patients were divided into combination group(n=29,receiving TACE plus apatinib)and control group(n=86,receiving TACE alone).By using propensity score matching method with 1∶1 ratio,the clinical effects of the two groups were analyzed.The overall survival(OS)and progression-free survival(PFS)were the main observation indicators,the tumor response and apatinib-related adverse reactions were the minor observation indicators.Results A total of 25 pairs were matched,and the baseline data between groups were comparable.After pair-matching,the 1-year,2-year and 3-year survival rates in the combination group were 68%,32%and8%respectively,which were significantly better than 44%,20%and 0%respectively in the control group(P=0.046).Before pair-matching,the median OS(mOS)and PFS(mPFS)in the combination group were 19 months and 14 months respectively,which were 12 months and 4 months respectively in the control group(P<0.05).After pair-matching,the mOS and mPFS in the combination group were 18 months and 10 months respectively,which were 9 months and 5 months respectively in the control group(P<0.05).In the combination group,the tumor response rate and disease control rate were much better and no severe adverse reactions occurred.Conclusion For the treatment of middle-stage and advanced HCC,TACE plus apatinib can significantly prolong OS and PFS,besides,the tumor response rate and tumor control rate can be remarkably improved when compared with TACE alone.(J Intervent Radiol,2021,30:724-729)