Recent advances in systemic and locoregional treatments for patients with unresectable or advanced hepatocellular carcinoma(HCC)have resulted in improved response rates.This has provided an opportunity for selected pa...Recent advances in systemic and locoregional treatments for patients with unresectable or advanced hepatocellular carcinoma(HCC)have resulted in improved response rates.This has provided an opportunity for selected patients with initially unresectable HCC to achieve adequate tumor downstaging to undergo surgical resection,a‘conversion therapy’strategy.However,conversion therapy is a new approach to the treatment of HCC and its practice and treatment protocols are still being developed.Review the evidence for conversion therapy in HCC and develop consensus statements to guide clinical practice.Evidence review:Many research centers in China have accumulated significant experience implementing HCC conversion therapy.Preliminary findings and data have shown that conversion therapy represents an important strategy to maximize the survival of selected patients with intermediate stage to advanced HCC;however,there are still many urgent clinical and scientific challenges for this therapeutic strategy and its related fields.In order to summarize and learn from past experience and review current challenges,the Chinese Expert Consensus on Conversion Therapy for Hepatocellular Carcinoma(2021 Edition)was developed based on a review of preliminary experience and clinical data from Chinese and non-Chinese studies in this field and combined with recommendations for clinical practice.Sixteen consensus statements on the implementation of conversion therapy for HCC were developed.The statements generated in this review are based on a review of clinical evidence and real clinical experience and will help guide future progress in conversion therapy for patients with HCC.展开更多
Background:To compare the treatment effectiveness and safety among transarterial infusion chemotherapy(TAI)with FOLFOX regimen,transarterial chemoembolization(TACE),and sorafenib in patients with BCLC stage C hepatoce...Background:To compare the treatment effectiveness and safety among transarterial infusion chemotherapy(TAI)with FOLFOX regimen,transarterial chemoembolization(TACE),and sorafenib in patients with BCLC stage C hepatocellular carcinoma(HCC).Methods:The data of consecutive patients with BCLC stage C HCC treated with TAI,TACE,or sorafenib from January 2015 to December 2018 at three centers were retrospectively analyzed.Propensity-score matched(PSM)analysis was pairwise performed to reduce selection bias.Treatment effectiveness and safety were evaluated and compared using the Kaplan-Meier method,log-rank test,Cox regression models,andχ2 test.Results:The median overall survival(OS)in the matched TAI cohort was significantly longer than the sorafenib cohort(19.6 vs.7.5 months,P=0.009),and the TACE cohort(estimated 27.8 vs.6.6 months,P<0.001).The difference in median progression-free survival(PFS)between the matched TAI and sorafenib cohorts was not significant(5.8 vs.2.3 months,P=0.219).The median PFS in the matched TAI cohort was significantly longer than the TACE cohort(6.5 vs.2.8 months,P<0.001).The objective response rate(ORR)in the matched TAI cohort was significantly higher than the sorafenib cohort(36.4%vs.0.0%,P<0.001)and the TACE cohort(48.7%vs.4.7%,P<0.001).The incidences of adverse events(AEs)were similar among these three cohorts.Conclusions:TAI with FOLFOX regimen was an effective and safe therapy that improved survival of patients with BCLC stage C HCC.展开更多
文摘Recent advances in systemic and locoregional treatments for patients with unresectable or advanced hepatocellular carcinoma(HCC)have resulted in improved response rates.This has provided an opportunity for selected patients with initially unresectable HCC to achieve adequate tumor downstaging to undergo surgical resection,a‘conversion therapy’strategy.However,conversion therapy is a new approach to the treatment of HCC and its practice and treatment protocols are still being developed.Review the evidence for conversion therapy in HCC and develop consensus statements to guide clinical practice.Evidence review:Many research centers in China have accumulated significant experience implementing HCC conversion therapy.Preliminary findings and data have shown that conversion therapy represents an important strategy to maximize the survival of selected patients with intermediate stage to advanced HCC;however,there are still many urgent clinical and scientific challenges for this therapeutic strategy and its related fields.In order to summarize and learn from past experience and review current challenges,the Chinese Expert Consensus on Conversion Therapy for Hepatocellular Carcinoma(2021 Edition)was developed based on a review of preliminary experience and clinical data from Chinese and non-Chinese studies in this field and combined with recommendations for clinical practice.Sixteen consensus statements on the implementation of conversion therapy for HCC were developed.The statements generated in this review are based on a review of clinical evidence and real clinical experience and will help guide future progress in conversion therapy for patients with HCC.
基金This study was supported by the National Natural Science Foundation of China(No.81871985)Natural Science Foundation of Guangdong Province(No.2018A0303130098 and No.2017A030310203)+4 种基金Science and Technology Planning Project of Guangdong Province(No.2017A020215112)Medical Scientific Research Foundation of Guangdong Province(No.A2017477)Science and Technology Planning Project of Guangzhou(No.201903010017 and No.201904010479)Clinical Trials Project(5010 Project)of Sun Yat-sen University(No.5010-2017009)and Clinical Trials Project(308 Project)of Sun Yat-sen University Cancer Center(No.308-2015-014).
文摘Background:To compare the treatment effectiveness and safety among transarterial infusion chemotherapy(TAI)with FOLFOX regimen,transarterial chemoembolization(TACE),and sorafenib in patients with BCLC stage C hepatocellular carcinoma(HCC).Methods:The data of consecutive patients with BCLC stage C HCC treated with TAI,TACE,or sorafenib from January 2015 to December 2018 at three centers were retrospectively analyzed.Propensity-score matched(PSM)analysis was pairwise performed to reduce selection bias.Treatment effectiveness and safety were evaluated and compared using the Kaplan-Meier method,log-rank test,Cox regression models,andχ2 test.Results:The median overall survival(OS)in the matched TAI cohort was significantly longer than the sorafenib cohort(19.6 vs.7.5 months,P=0.009),and the TACE cohort(estimated 27.8 vs.6.6 months,P<0.001).The difference in median progression-free survival(PFS)between the matched TAI and sorafenib cohorts was not significant(5.8 vs.2.3 months,P=0.219).The median PFS in the matched TAI cohort was significantly longer than the TACE cohort(6.5 vs.2.8 months,P<0.001).The objective response rate(ORR)in the matched TAI cohort was significantly higher than the sorafenib cohort(36.4%vs.0.0%,P<0.001)and the TACE cohort(48.7%vs.4.7%,P<0.001).The incidences of adverse events(AEs)were similar among these three cohorts.Conclusions:TAI with FOLFOX regimen was an effective and safe therapy that improved survival of patients with BCLC stage C HCC.
