肝动脉灌注奥沙利铂加氟尿嘧啶/亚叶酸钙与索拉非尼治疗晚

StephenW

Hepatic arterial infusion of oxaliplatin plus fluorouracil/leucovorin vs. sorafenib for advanced hepatocellular carcinoma

Ning Lyu†
, Yanan Kong†
, Luwen Mu
, Youen Lin
, Jibin Li
, Yaru Liu
, Zhenfeng Zhang
, Lie Zheng
, Haijing Deng
, Shaolong Li
, Qiankun Xie
, Rongping Guo
, Ming Shi
, Li Xu
, Xiuyu Cai
, Peihong Wu
, Ming Zhao' Correspondence information about the author Ming Zhao Email the author Ming Zhao



DOI:            https://doi.org/10.1016/j.jhep.2018.02.008 |

• Graphical abstract
  

Highlights

• •Hepatic arterial infusion was proven to be an effective and safe treatment in advanced HCC.
• •Hepatic arterial infusion therapy was an independent factor for PFS and OS.
• •Hepatic arterial infusion therapy provided a potential benefit of survival in patients with advanced HCC.
  

Background & AimsTo compare the overall survival (OS) and disease progression free survival (PFS) in patients with advanced hepatocellular carcinoma (Ad-HCC) who are undergoing hepatic arterial infusion (HAI) of oxaliplatin, fluorouracil/leucovorin (FOLFOX) treatment vs. sorafenib.


MethodsThis retrospective study was approved by the ethical review committee, and informed consent was obtained from all patients before treatment. HAI of FOLFOX (HAIF) was recommended as an alternative treatment option for patients who refused sorafenib. Of the 412 patients with Ad-HCC (376 men and 36 women) between Jan 2012 to Dec 2015, 232 patients were treated with sorafenib; 180 patients were given HAIF therapy. The median age was 51 years (range, 16–82 years). Propensity-score matched estimates were used to reduce bias when evaluating survival. Survival curves were calculated by performing the Kaplan-Meier method and compared by using the log-rank test and Cox regression models.


Results The median PFS and OS in the HAIF group were significantly longer than those in the sorafenib group (PFS 7.1 vs. 3.3 months [RECIST]/7.4 vs. 3.6 months [mRECIST], respectively; OS 14.5 vs. 7.0 months; p <0.001 for each). In the propensity-score matched cohorts (147 pairs), both PFS and OS in the HAIF group were longer than those in the sorafenib group (p <0.001). At multivariate analysis, HAIF treatment was an independent factor for PFS (hazard ratio [HR] 0.389 [RECIST]/0.402 [mRECIST]; p <0.001 for each) and OS (HR 0.129; p <0.001).


Conclusion HAIF therapy may improve survival compared to sorafenib in patients with Ad-HCC. A prospective randomized trial is ongoing to confirm this finding.


Lay summary We compared the hepatic arterial infusion of FOLFOX (a combination chemotherapy) with sorafenib (a tyrosine kinase inhibitor) in patients with advanced hepatocellular carcinoma, retrospectively. It was found that hepatic arterial infusion of FOLFOX therapy may improve both progression free and overall survival in patients with advanced hepatocellular carcinoma.



chemotherapy&seriesISSN=0168-8278]Arterial infusion chemotherapy[/url], FOLFOX, Oxaliplatin, Fluorouracil

StephenW

肝动脉灌注奥沙利铂加氟尿嘧啶/亚叶酸钙与索拉非尼治疗晚期肝细胞癌
Ning Lyu†
，Yanan Kong†
，鲁文姆
，林宥嘉
，李吉宾
，刘亚如
，张振峰
，李正
，海景邓
，少龙李
，谢干坤
，郭荣平
，明仕
，李旭
，秀玉才
，吴培红
，赵鸣'作者信函作者赵明Email给作者赵铭
PlumX指标
DOI：https：//doi.org/10.1016/j.jhep.2018.02.008 |

强调

    •肝动脉灌注被证明是晚期HCC的有效和安全治疗。
    •肝动脉灌注治疗是PFS和OS的独立因素。
    •肝动脉灌注治疗为晚期HCC患者提供了潜在的生存益处。

背景和目的

比较接受奥沙利铂，氟尿嘧啶/亚叶酸钙（FOLFOX）治疗与索拉非尼治疗的进展性肝细胞癌（Ad-HCC）患者的总生存期（OS）和无进展生存期（PFS）。
方法

该回顾性研究经伦理审查委员会批准，并在治疗前获得所有患者的知情同意书。 FOLFOX HAI（HAIF）被推荐为拒绝索拉非尼患者的替代治疗选择。 2012年1月至2015年12月期间，412例Ad-HCC患者（376例男性，36例女性）中，232例患者接受索拉非尼治疗; 180名患者接受了HAIF治疗。中位年龄为51岁（范围16-82岁）。在评估生存时，倾向评分匹配评估用于减少偏倚。通过执行Kaplan-Meier方法计算生存曲线，并通过使用对数秩检验和Cox回归模型进行比较。
结果

HAIF组的中位PFS和OS显着长于索拉非尼组（PFS 7.1比3.3个月[RECIST] /7.4对3.6个月[mRECIST]，OS 14.5 vs. 7.0个月; p <0.001为每个）。在倾向评分匹配队列（147对）中，HAIF组的PFS和OS均长于索拉非尼组（p <0.001）。在多变量分析中，HAIF治疗是PFS（危险比[HR] 0.389 [RECIST] /0.402 [mRECIST];各自为p <0.001）和OS（HR 0.129; p <0.001）的独立因素。
结论

与Ad-HCC患者中的索拉非尼相比，HAIF治疗可以提高存活率。目前正在进行一项前瞻性随机试验来证实这一发现。
总结

我们比较了肝动脉输注FOLFOX（联合化疗）和索拉非尼（一种酪氨酸激酶抑制剂）在晚期肝细胞癌患者中的回顾性分析。发现肝动脉灌注FOLFOX治疗可以改善晚期肝细胞癌患者的无进展和总生存期。
关键词：
肝细胞癌，索拉非尼，动脉灌注化疗，FOLFOX，奥沙利铂，氟尿嘧啶