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Transarterial chemoembolization plus immune checkpoint inhibitor as postoperative adjuvant therapy for hepatocellular carcinoma with portal vein tumor thrombus: A multicenter cohort study
Institution:1. Cancer Center, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200083, China;2. Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jiaxing, The First Affiliated Hospital of Jiaxing University, Jiaxing, 314001, Zhejiang, China;3. Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200433, China;4. Department of Hepatobiliary Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200083, China;5. Tongji University Cancer Center, Shanghai Tenth People''s Hospital, School of Medicine, Tongji University, Shanghai, 200072, China;1. Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China;2. Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China;1. Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia;2. Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia;3. Institute of Academic Surgery at RPA, Sydney, Australia;4. University of Sydney, New South Wales, Australia;5. Department of Urology, Royal Prince Alfred Hospital, Sydney, Australia;1. Translational Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland;2. Department of Biological and Environmental Science, University of Jyväskylä, 40014, Jyväskylä, Finland;3. Department of Pathology, Central Finland Health Care District, 40620, Jyväskylä, Finland;4. Department of Education and Research, Central Finland Health Care District, 40620, Jyväskylä, Finland;5. Faculty of Sport and Health Sciences, University of Jyväskylä, 40014, Jyväskylä, Finland;6. Faculty of Medicine and Health Technology, Tampere University and TAYS Cancer Center, Tampere University Hospital, 33520, Tampere, Finland;7. Department of Gastrointestinal Surgery, Helsinki University Central Hospital, University of Helsinki, 00290, Helsinki, Finland;8. Applied Tumor Genomics, Research Program Unit, University of Helsinki, 00290, Helsinki, Finland;9. Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, 33520, Tampere, Finland;10. Central Hospital of Central Finland, 40014, Jyväskylä, Finland;11. Department of Cardiothoracic Surgery, Oulu University Hospital, Oulu, Finland;12. University Hospital and University of Oulu, 90014, Oulu, Finland;1. Department of Radiology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, PR China;2. Department of Gastroenterology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, PR China;3. Medical Science and Technology Innovation Center, Shandong First Medical University, Jinan, Shandong, PR China;1. Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA;2. Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt;3. Department of General Surgery, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel;4. Department of General Surgery, Faculty of Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem, Israel;5. Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, Affiliated with the Faculty of Medicine, Tel Aviv University, Israel;1. Department of Surgery, Kristianstad Central Hospital, Kristianstad, Sweden;2. Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden;3. Department of Surgery, Skåne University Hospital, Malmö, Sweden;4. Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden;5. Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund, Sweden;6. Lund University Cancer Centre, Lund, Sweden;7. Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
Abstract:PurposeThis study aimed to assess the efficacy and safety of postoperative adjuvant transarterial chemoembolization (PA-TACE) plus immune checkpoint inhibitor (ICI) for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT).Patients and methodsThis study was conducted on three centers from June 2018 to December 2020. Patients were divided into the PA-TACE (n = 48) and PA-TACE plus ICI groups (n = 42). The recurrence-free survival (RFS) and overall survival (OS) curves were depicted by Kaplan-Meier method, and the differences between the two groups were compared using log-rank test. Univariate and multivariate Cox analyses were performed to identify independent risk factors for RFS and OS. Adverse events (AEs) were assessed according to the Common Terminology Criteria for AEs (CTCAE) version 5.0.ResultsThe median RFS of the PA-TACE plus ICI group was significantly longer than the PA-TACE group (12.76 months vs. 8.11 months; P = 0.038). The median OS of the PA-TACE plus ICI group was also significanfly better than the PA-TACE group (24.5 months vs. 19.1 months; P = 0.032). PA-TACE plus ICI treatment was an independent prognostic factor for RFS (HR: 0.54, 95% CI: 0.32–0.9, P = 0.019) and OS (HR: 0.47, 95% CI: 0.26–0.86, P = 0.014). Only one patient experienced grade ≥3 immune-related AEs in the PA-TACE plus ICI group.ConclusionsPA-TACE plus ICI treatment had better efficacy in preventing recurrence and prolonging survival than PA-TACE alone for HCC patients with PVTT after R0 resection. This novel treatment modality may be an appropriate option for HCC with PVTT.
Keywords:Hepatocellular carcinoma (HCC)  Portal vein tumor thrombus (PVTT)  Surgical resection  Postoperative adjuvant transarterial chemoembolization (PA-TACE)  Immune checkpoint inhibitor (ICI)  ICI"}  {"#name":"keyword"  "$":{"id":"pc_xEqmwgiA37"}  "$$":[{"#name":"text"  "_":"immune checkpoint inhibitor  PA-TACE"}  {"#name":"keyword"  "$":{"id":"pc_MDziHRcXo2"}  "$$":[{"#name":"text"  "_":"postoperative adjuvant transarterial chemoembolization  PVTT"}  {"#name":"keyword"  "$":{"id":"pc_85SJpPKolu"}  "$$":[{"#name":"text"  "_":"portal vein tumor thrombus  HCC"}  {"#name":"keyword"  "$":{"id":"pc_sg8IpSwFLs"}  "$$":[{"#name":"text"  "_":"hepatocellular carcinoma  OS"}  {"#name":"keyword"  "$":{"id":"pc_N8M83ouxlb"}  "$$":[{"#name":"text"  "_":"overall survival  RFS"}  {"#name":"keyword"  "$":{"id":"pc_VFhAUDTcMA"}  "$$":[{"#name":"text"  "_":"recurrence-free survival
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