肝动脉化疗栓塞联合卡瑞利珠单抗治疗中晚期肝细胞癌的疗效分析

Hepatic arterial chemoembolization combined with camrelizumab for the treatment of mid-to-advanced hepatocellular carcinoma: analysis of its curative efficacy

目的 评估肝动脉化疗栓塞(TACE)联合卡瑞利珠单抗治疗中晚期肝细胞癌(HCC)患者的疗效。方法 回顾性分析2019年6月至2021年9月106例中晚期HCC患者的临床资料。患者中接受TACE联合卡瑞利珠单抗治疗71例(联合组),接受单药卡瑞利珠单抗治疗35例(对照组)。按1∶1比例应用倾向性得分匹配(PSM)分析2组患者疗效。主要研究终点为总生存期(OS),次要研究终点为无进展生存期(PFS)。结果 成功匹配32对患者。PSM前,TACE联合卡瑞利珠单抗组的OS和PFS均高于单独卡瑞利珠单抗组(20.2个月比10.7个月,P=0.001;8.2个月比5.2个月,P=0.002)。PSM后,联合治疗组OS和PFS仍优于对照组(19.6个月比10.7个月,P=0.043;7.7个月比5.2个月,P=0.013)。PSM前多因素分析显示,单药卡瑞利珠单抗(P=0.006)和Child B级(P=0.027)是患者预后较差的影响因素,而PSM后的多因素分析并未发现影响患者OS的独立预后因素。此外,2组患者的治疗相关不良反应的发生率相似,差异无统计学意义(均P>0.05)。结论 TACE联合卡瑞利珠单抗治疗中晚期肝癌比单药卡瑞利珠单抗具有更好的生存获益,并且安全可控。

Objective To evaluate the curative efficacy of transcatheter arterial chemoembolization(TACE) combined with camrelizumab for the treatment of mid-to-advanced hepatocellular carcinoma(HCC).Methods The clinical data of 106 patients with mid-to-advanced HCC, who received treatment between June2019 and September 2021, were retrospectively analyzed. Of the 106 patients, 71 received TACE combined with camrelizumab(combination group) and 35 received camrelizumab alone(control group). By using propensity score matching(PSM) with 1∶1 ratio, the curative efficacy of the two groups was analyzed. The primary study endpoint was overall survival(OS), and the secondary study endpoint was progression-free survival(PFS).Results A total of 32 pairs of patients were successfully matched. Before PSM, the median OS(20.2 months vs.10.7 months, P=0.001) and the median PFS(8.2 months vs. 5.2 months, P=0.002) in the combination group were remarkably higher than those in the control group. After PSM, the median OS(19.6 months vs. 10.7 months,P=0.043) and the median PFS(7.7 months vs. 5.2 months, P =0.013) in the combination group were still higher than those in the control group. Before PSM, multivariate analysis showed that the single-agent camrelizumab(P = 0. 006) and Child grade B(P=0.027) were independent prognostic factors for poor OS.However, multivariate analysis after PSM did not find independent prognostic factors for OS. Besides, the incidence of treatment-related adverse reactions in the two groups was similar, and the difference was not statistically significant(all P>0.05). Conclusion For the treatment of mid-to-advanced HCC,TACE combined with camrelizumab is superior to single-agent camrelizumab in achieving better survival benefits, safety and controllability.(J Intervent Radiol, 2022, 31: 865-870)