| 摘要: |
| 目的 探索转化治疗对合并大血管侵犯的晚期肝细胞癌（HCC）的疗效和安全性。方法 回顾性选择2019年7月至2021年6月就诊于我院的149例合并大血管侵犯的晚期HCC患者。所有患者接受系统治疗联合局部治疗，根据最终是否接受手术治疗分为转化治疗组（n＝42）和非转化治疗组（n＝107），分析转化治疗后的长期预后和不良反应。结果 149例患者的中位无事件生存期为15.5个月，中位总生存期尚未达到。转化治疗组和非转化治疗组的中位无事件生存期分别为19.8个月和10.7个月，中位总生存期分别为未达到和28.2个月。多因素Cox回归分析显示，转化治疗是总生存期的保护因素（HR＝0.125，95%CI 0.016～0.966），但不是无事件生存期的影响因素。转化治疗组和非转化治疗组的1年、2年总生存率分别为100.0%、96.4%和72.1%、53.4%，两组生存曲线差异有统计学意义（P＝0.003）；1年、2年无事件生存率分别为77.5%、33.8%和47.3%、31.5%，两组生存曲线差异无统计学意义（P＝0.070）。转化治疗组和非转化治疗组患者的靶向和免疫治疗相关不良反应总发生率［66.7%（28/42）vs 72.0%（77/107），P＝0.524］及Ⅲ～Ⅳ级不良反应发生率［23.8%（10/42）vs 27.1%（29/107），P＝0.681］差异均无统计学意义。结论 转化治疗可以明显改善伴有大血管侵犯的晚期HCC患者的预后，并且不会导致严重的不良反应。 |
| 关键词: 肝肿瘤 肝细胞癌 大血管侵犯 转化治疗 预后 不良反应 |
| DOI：10.16781/j.CN31-2187/R.20240437 |
| 投稿时间：2024-06-19修订日期：2024-12-27 |
| 基金项目:上海市科学技术委员会探索者计划（21TS1400500），上海市卫生健康委员会科研项目（20234Y0151），海军军医大学（第二军医大学）第三附属医院腾飞工程人才计划（TF2024XSYJ04）． |
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| Efficacy of conversion therapy for advanced hepatocellular carcinoma patients with macrovascular invasion |
| LIU Jianwei1,WANG Kui1*,XIA Yong2,XUE Hui1,TANG Ming2,ZHANG Xiaofeng2 |
(1. Department of Hepatic Surgery (Ⅱ), The Third Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200438, China;
2. Department of Hepatic Surgery (Ⅳ), The Third Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200438, China
*Corresponding author) |
| Abstract: |
| Objective To explore the efficacy and safety of conversion therapy for advanced hepatocellular carcinoma (HCC) with macrovascular invasion. Methods A total of 149 patients with advanced HCC with macrovascular invasion who were treated at our hospital from Jul. 2019 to Jun. 2021 were enrolled. All patients received systemic therapy combined with local therapy, and were assigned to conversion therapy group (n＝42) and non-conversion therapy group (n＝107) according to whether they ultimately underwent surgical treatment. The long-term prognosis and adverse reactions of these patients after conversion therapy were analyzed. Results The median event-free survival of 149 patients was 15.5 months, and the median overall survival had not been reached. The median event-free survival in the conversion therapy and non-conversion therapy groups were 19.8 months and 10.7 months, respectively, with the median overall survival being not reached and 28.2 months, respectively. Multifactor Cox regression analysis showed that conversion therapy was a protective factor for overall survival (hazard ratio ［HR］ ＝0.125, 95% confidence interval ［CI］ 0.016-0.966), but not for event-free survival. The 1-year and 2-year overall survival rates of the conversion therapy and non-conversion therapy groups were 100.0%, 96.4% and 72.1%, 53.4%, respectively, and the difference in survival curves between the 2 groups was statistically significant (P＝0.003). The 1-year and 2-year event-free survival rates were 77.5%, 33.8% and 47.3%, 31.5%, respectively. There was no significant difference in survival curves between the 2 groups (P＝0.070). The differences of the overall incidences of targeted and immunotherapy-related adverse reactions in the conversion therapy group and non-conversion therapy group (66.7% ［28/42］ vs 72.0% ［77/107］, P＝0.524) and the incidences of grade Ⅲ to Ⅳ adverse reactions (23.8% ［10/42］ vs 27.1% ［29/107］, P＝0.681), were not statistically significant. Conclusion For patients with advanced HCC with macrovascular invasion, conversion therapy can significantly improve the prognosis without serious adverse reactions. |
| Key words: liver neoplasms hepatocellular carcinoma macrovascular invasion conversion therapy prognosis adverse reaction |
