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对肝细胞癌的局部区域治疗加上免疫治疗的完整反应

Chi Leung Chiang^1,2, Kenneth Sik Kwan Chan³, Keith Wan Hang Chiu^4,5

¹Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong and University of Hong Kong-Shenzhen Hospital, Hong Kong, China.

|September 26, 2024

概括

局部晚期肝细胞癌 (HCC) 患者通过局部区域疗法 (LRT) 加上免疫疗法 (IO) 实现完全缓解 (CR),表现出持久的反应和在观察和等待协议下可实现的长期存活.

科学领域:

肝胆瘤学肝胆瘤学
免疫治疗是一种免疫疗法.
地方区域疗法地方区域疗法

背景情况:

局部晚期肝细胞癌 (HCC) 通常需要多模式治疗.
结合的局部区域疗法 (LRT) 和免疫疗法 (IO) 可以在很大比例的HCC患者中实现完全缓解 (CR).
在没有手术的情况下进行LRT-IO后,CR的长期结果和预测因素尚未确定.

研究的目的:

评估在LRT-IO后获得CR的不可切除的HCC患者的长期临床结果,并通过观察和等待方法进行管理.
在这个患者队列中确定CR的预测因子.

主要方法:

一项队列研究包括63名无法切除的HCC患者,他们在LRT-IO (立体体辐射疗法 +/- 跨动脉化学栓塞,随后进行抗PD1/PD-L1疗法) 后实现了放射性CR.
患者在没有手术或进一步IO的情况下进行监测.
结果包括3年总生存期 (OS),进展时间 (TTP),局部控制和复发模式. 多变量分析确定了CR的预测因素.

主要成果:

46.0% (29/63) 的患者实现了CR.
获得CR的患者与没有CR的患者相比,有显著改善的3年生存率 (75.5%).
在CR患者中,3年TTP为58.7%,局部控制为90.5%. 没有血管侵袭和较小的瘤负担 (最大病变直径的总和≤8厘米) 预测CR.

结论:

随着观察和等待策略的LRT-IO之后,可以在获得CR的局部发达不可切除的HCC患者中带来持久的反应和长期存活.
预测CR的预测因素包括无血管入侵和有限的瘤大小.
需要进一步的随机试验来证实这些发现.

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