摘要
目的:免疫检查点抑制剂与抗血管生成药物联合局部治疗正逐渐成为中晚期肝细胞癌(hepatocellular carcinoma,HCC)的一线治疗手段。然而,靶免联合治疗仍存在一些不足之处,如治疗有效率较低等。精准筛选能治疗获益的患者仍是一项挑战。本研究拟探讨超声造影(contrast-enhanced ultrasound,CEUS)定量参数在免疫检查点抑制剂联合抗血管生成药物治疗中晚期HCC中的疗效预测作用。方法:研究前瞻性地纳入接受免疫检查点抑制剂与抗血管生成药物联合局部治疗(经肝动脉化疗栓塞或肝动脉灌注化疗)的HCC患者。治疗前进行基线CEUS检查,并使用灌注量化软件分析获得肿瘤灌注参数。根据疗效分为缓解组与未缓解组,比较两组间CEUS定量参数的差异,评估参数与无进展生存期(progression-free survival,PFS)间的相关性。结果:入组66例患者的客观缓解率为21.2%。靶病灶与背景肝组织的灌注参数比值,如上升时间比值、达峰时间比值、下降时间比值、峰值增强比值、流入率比值、流入灌注指数比值和流出率比值在缓解组与未缓解组间差异有统计学意义(均P<0.05)。仅有上升时间比值是影响客观缓解率的独立影响因素(P=0.010)。缓解组与未缓解组的中位上升时间比值分别为36.9和58.9(P=0.006)。通过X-tile程序确定上升时间比值的最佳截断值为80.1。生存分析显示,低上升时间比值患者的PFS较长(高上升时间比值vs低上升时间比值为4.4个月vs 19.1个月,P=0.044)。结论:CEUS定量参数对预测免疫检查点抑制剂联合抗血管生成药物治疗HCC患者的疗效有一定价值。
Objective:Immune checkpoint inhibitors and angiogenesis inhibitors combined with locoregional therapies is gradually becoming the first-line treatment for intermediate and advanced hepatocellular carcinoma(HCC).However,targetimmunotherapy still has some shortcomings,such as a relatively low effective rate of treatment.Accurately screening patients who may benefit from treatment remains a challenge.This study intends to explore the predictive role of quantitative parameters of contrast-enhanced ultrasound(CEUS)on the tumor response in patients with intermediate and advanced HCC treated with immune checkpoint inhibitors and angiogenesis inhibitors(VEGF inhibitors)combined with locoregional therapies.Methods:HCC patients treated with immune checkpoint inhibitors and VEGF inhibitors combined with locoregional therapies(transarterial chemoembolization or hepatic arterial infusion chemotherapy)were prospectively enrolled.Baseline CEUS examination was performed before treatment,and the tumor perfusion quantitative parameters were analyzed using perfusion quantification software.Tumor response and progression-free survival(PFS)were assessed in these patients.All patients were divided into the response group and the non-response group.The differences in quantitative parameters of CEUS between the two groups were compared,and the correlation between the CEUS parameters and PFS was evaluated.Results:The objective response rate of the 66 enrolled patients was 21.2%.The ratios of perfusion parameters between the target lesion and the background liver tissue,such as the rising time ratio,time to peak ratio,fall time ratio,peak enhancement ratio,wash-in rate ratio,wash-in perfusion index ratio,and wash-out rate ratio,showed significant differences between the response group and the non-response group(all P values were<0.05).Only the rising time ratio was an independent factor affecting the objective response rate(P=0.010).The median rising time ratio of the response group and the non-response group were 36.9 and 58.9,respectively(P=0.006).The optimal cutoff value of the rising time ratio was determined to be 80.1 through the X-tile program.Survival analysis showed that patients with a low rising time ratio had a longer PFS(high rising time ratio vs low rising time ratio was 4.4 months vs 19.1 months,P=0.044).Conclusion:The quantitative parameters of CEUS before treatment may have certain value in early predicting the efficacy of immune checkpoint inhibitors and VEGF inhibitors-based combination therapies for HCC.
作者
郑瑞映
张艺
刘明
张晓儿
刘保娴
谢晓燕
黄光亮
ZHENG Ruiying;ZHANG Yi;LIU Ming;ZHANG Xiaoer;LIU Baoxian;XIE Xiaoyan;HUANG Guangliang(Department of Interventional Ultrasound,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,Guangdong Province,China;Department of Medical Ultrasonics,Guangxi Hospital Division of The First Affiliated Hospital,Sun Yat-sen University,Nanning 530022,Guangxi Province,China)
出处
《肿瘤影像学》
2026年第1期10-18,共9页
Oncoradiology
基金
国家自然科学基金(92059201)
广西医疗卫生适宜技术开发与推广应用项目(S2023005)
广东省基础与应用基础研究基金企业联合基金(2023A1515220152)。
关键词
肝细胞癌
靶免治疗
超声造影
免疫检查点抑制剂
抗血管生成药物
肿瘤应答
Hepatocellular carcinoma
Targeted and immunotherapy therapy
Contrast-enhanced ultrasound
Immune checkpoint inhibitor
Angiogenesis inhibitor
Tumor response
