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  • [Cancers (Basel) .] A Real-World Comparative Analysis of Atezolizumab Plus Bevacizumab and Transarterial Chemoembolization Plus Radiotherapy in Hepatocellular Carcinoma Patients with Portal Vein Tumor Thrombosis

    가톨릭의대 / 이순규, 권정현*

  • 출처
    Cancers (Basel) .
  • 등재일
    2023 Sep 4
  • 저널이슈번호
    15(17):4423. doi: 10.3390/cancers15174423.
  • 내용

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    Abstract
    This study aimed to compare the treatment outcomes of atezolizumab-plus-bevacizumab (Ate/Bev) therapy with those of transarterial chemoembolization plus radiotherapy (TACE + RT) in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) and without metastasis. Between June 2016 and October 2022, we consecutively enrolled 855 HCC patients with PVTT. After excluding 758 patients, 97 patients (n = 37 in the Ate/Bev group; n = 60 in the TACE + RT group) were analyzed. The two groups showed no significant differences in baseline characteristics and had similar objective response and disease control rates. However, the Ate/Bev group showed a significantly higher one-year survival rate (p = 0.041) compared to the TACE + RT group, which was constantly displayed in patients with extensive HCC burden. Meanwhile, the clinical outcomes were comparable between the two groups in patients with unilobar intrahepatic HCC. In Cox-regression analysis, Ate/Bev treatment emerged as a significant factor for better one-year survival (p = 0.049). Finally, in propensity-score matching, the Ate/Bev group demonstrated a better one-year survival (p = 0.02) and PFS (p = 0.01) than the TACE + RT group. In conclusion, Ate/Bev treatment demonstrated superior clinical outcomes compared to TACE + RT treatment in HCC patients with PVTT. Meanwhile, in patients with unilobar intrahepatic HCC, TACE + RT could also be considered as an alternative treatment option alongside Ate/Bev therapy.

     

     

    Affiliations

    Soon Kyu Lee 1 2, Jung Hyun Kwon 1 2, Sung Won Lee 2 3, Hae Lim Lee 2 3, Hee Yeon Kim 2 3, Chang Wook Kim 2 4, Do Seon Song 2 5, U Im Chang 2 5, Jin Mo Yang 2 5, Soon Woo Nam 1 2, Seok-Hwan Kim 2 6, Myeong Jun Song 2 6, Ji Hoon Kim 2 4, Ahlim Lee 2 5, Hyun Yang 2 7, Si Hyun Bae 2 7, Ji Won Han 2 8, Heechul Nam 2 4, Pil Soo Sung 2 8, Jeong Won Jang 2 8, Jong Young Choi 2 8, Seung Kew Yoon 2 8, Dong Jae Shim 9, Doyoung Kim 9, Myungsoo Kim 10
    1Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
    2The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
    3Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
    4Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
    5Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
    6Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
    7Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
    8Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
    9Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
    10Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.

  • 키워드
    hepatocellular carcinoma; immune checkpoint inhibitors; portal vein thrombosis; progression free survival; radiotherapy; response; survival; transarterial chemoembolization.
  • 편집위원

    간문맥 종양혈전을 동반한 간세포암에서 Atezolizumab+Bevacizumab (Ate+Bev) 치료와 경동맥항암화학색전술+방사선치료 (TACE+RT) 의 결과를 비교 분석한 연구로, 1년 전체생존율과 무병생존율(PFS) 측면에서는 Ate+Bev이 더 높은 것으로 나왔으나, 단엽(unilobar) 간세포암에서는 치료 결과가 비슷한 것으로 보고했다. 따라서 간문맥 종양혈전을 동반한 단엽 간세포암의 경우 TACE+RT가 alternative treatment option으로 고려해볼 수 있다는 결론을 내었다.

    2023-11-08 13:54:21

  • 편집위원2

    PVTT를 동반한 진행성 간세포암종에서 1차 치료제로 승인된 Ate/Bev에 대한 국내 치료 결과를 보고한 연구로 후향적 분석이지만 의의가 있습니다.대부분이 multiple HCCs이며 절반 정도가 vp4 PVTT를 동반한 진행성 병기임에도 기존 3상 임상시험에 비해 우월한 생존율을 보여주었는데 간외전이를 배제하였다 하더라도 해석에 주의를 요하고 방사선치료 관련해서는 자세한 기술이나 분석 없이 생존율만 비교하는 한계점을 가지고 있습니다.

    2023-11-08 14:00:07

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