单纯肝动脉化疗栓塞及其联合经肝动脉灌注化疗治疗中晚期肝细胞癌的疗效对比

Comparison of the efficacy of transcatheter arterial chemoembolization(TACE)alone and combined hepatic arterial infusion chemotherapy(HAIC)in the treatment of advanced hepatocellular carcinoma

目的:对比肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)联合经肝动脉灌注化疗(hepatic arterial infusion chemotherapy,HAIC)与单纯TACE治疗中晚期肝细胞癌(hepatocellular carcinoma,HCC)的疗效。方法:回顾性收集156例2018年3月至2021年10月在暨南大学附属第一医院诊断为中晚期肝细胞癌且接受TACE-HAIC联合(55例)及单纯TACE(101例)治疗患者的临床资料。通过倾向性评分匹配(propensity score matching,PSM)消除组间差异,对比不同队列组间总生存(overall survival,OS)时间、无进展生存(progression-free survival,PFS)时间及肿瘤应答率。同时,对比不同治疗方案不良反应发生率。结果:在PSM调整前队列中,TACE-HAIC联合治疗组中位OS时间(19.7个月vs.9.8个月,P=0.010)和中位PFS时间(10.7个月vs.5.1个月,P=0.008)显著优于单纯TACE治疗组。在肿瘤应答率方面,TACE-HAIC联合和单纯TACE治疗组客观缓解率(ORR,23.6%vs.16.8%,P=0.303)差异无统计学意义,而TACE-HAIC联合治疗组疾病控制率(DCR,72.7%vs.60.4%,P=0.024)更优于单纯TACE治疗组。经过1∶1 PSM后,获得78例匹配后队列。在PSM队列中,TACE-HAIC联合治疗组中位OS及PFS时间分别为19.1和10.7个月,而单纯TACE中位OS及PFS时间分别为7.4和5.0个月,TACE-HAIC联合治疗组生存获益更优(P<0.05)。在肿瘤应答方面,联合治疗在整体应答率及DCR更具优势,而组间ORR差异无统计学意义。在不良反应发生率方面,TACE-HAIC联合和单纯TACE治疗组组间差异比较无统计学意义(P>0.05)。结论:相较于传统单纯TACE治疗,TACE-HAIC联合方案治疗中晚期HCC具有更优的生存获益及肿瘤应答率且安全性相当。

Objective:To compare the efficacy of transcatheter arterial chemoembolization(TACE)combined with hepatic arterial infusion chemotherapy(HAIC)versus TACE alone in the treatment of advanced hepatocellular carcinoma(HCC).Methods:Retrospective clinical data from 156 patients diagnosed with advanced HCC and treated either with TACE combined with HAIC(55 cases)or TACE alone(101 cases)in the First Affiliated Hospital of Jinan University between March 2018 and October 2021 were collected.Propensity score matching(PSM)was employed to minimize between-group differences.Overall survival(OS),progression-free survival(PFS),tumor response rate,and adverse reaction rates were compared.Results:In the pre-adjusted PSM cohort,the TACE-HAIC group demonstrated significantly longer median OS(19.7 months vs.9.8 months,P=0.010)and median PFS(10.7 months vs.5.1 months,P=0.008)compared to the TACE alone group.Although the objective response rate(ORR)did not significantly differ between groups(23.6%vs.20.2%,P=0.303),the disease control rate(DCR)was higher in the TACE-HAIC group(72.7%vs.65.8%,P=0.024).After 1∶1 propensity score matching,a matched cohort of 78 cases showed that the TACE-HAIC group had significantly better median OS(19.1 months vs.7.4 months)and median PFS(10.7 months vs.5.0 months)than the TACE alone group(P<0.05).The combined treatment also exhibited advantages in overall response rate and DCR,with comparable incidence of adverse reactions between groups(P>0.05).Conclusion:The combination of TACE and HAIC offers superior survival benefits and tumor response rates compared to traditional TACE alone in treating advanced HCC,with good tolerability.