经肝动脉栓塞化疗(Transcatheter Arterial Chemoembolization, TACE)是目前全球范围内中晚期肝细胞肝癌(Hepatocellular Carcinoma, HCC)推荐的一线治疗方式,但由于中晚期HCC患者在肿瘤负荷和肝功能等方面存在较大的差异性,部分患者在...经肝动脉栓塞化疗(Transcatheter Arterial Chemoembolization, TACE)是目前全球范围内中晚期肝细胞肝癌(Hepatocellular Carcinoma, HCC)推荐的一线治疗方式,但由于中晚期HCC患者在肿瘤负荷和肝功能等方面存在较大的差异性,部分患者在接受多次TACE治疗后,靶病灶无法取得控制,为避免重复无效的TACE治疗影响患者肝功能及预后,TACE抵抗的概念被提出。当HCC患者发生TACE抵抗后,需及时终止TACE治疗而转换为其他治疗方式。在本篇综述中,主要探讨经肝动脉灌注化疗(Hepatic Artery Infusion Chemotherapy, HAIC)在治疗发生TACE抵抗的HCC患者中的价值。Transcatheter arterial chemoembolization (TACE) is currently the recommended first-line treatment for advanced hepatocyte carcinoma (HCC) worldwide. However, due to the significant heterogeneity in tumor burden and liver function among advanced HCC patients, some patients fail to control the target lesions after multiple TACE treatments. To avoid repetitive ineffective TACE treatments that may affect liver function and prognosis, the concept of TACE resistance has been proposed. Once HCC patients develop TACE resistance, TACE treatment should be promptly terminated and switched to other treatment modalities. In this review, the value of hepatic artery infusion chemotherapy (HAIC) in treating HCC patients with TACE resistance is mainly discussed.展开更多
BACKGROUND Prediction of HAIC treatment response is important for improving the prognosis in patients with hepatocellular carcinoma(HCC).The progression of HCC is related to hypercoagulability and angiogenesis.It is k...BACKGROUND Prediction of HAIC treatment response is important for improving the prognosis in patients with hepatocellular carcinoma(HCC).The progression of HCC is related to hypercoagulability and angiogenesis.It is known that ADAMTS13 and von Willebrand factor(VWF)are related to hypercoagulability.In addition,previous study reported that the association between ADAMTS13 and VWF,and angiogenesis via vascular endothelial growth factor(VEGF).Recently,ADAMTS13 and VWF have been associated with the prognosis in patients with various kinds of cancer undergoing chemotherapy.AIM To investigate whether ADAMTS13 and VWF become useful biomarkers of treatment response in HCC patients before the initiation of HAIC treatment.METHODS Seventy-two patients were enrolled in this study.ADAMTS13 activity(ADAMTS13:AC),VWF antigen(VWF:Ag)and VEGF levels were determined via enzyme-linked immunosorbent assay.Univariable and multivariable analyses were performed to determine the predictive factors of treatment response in patients with HCC undergoing HAIC treatment.RESULTS ADAMTS13:AC levels in HCC patients with stable disease(SD)+partial response(PR)of HAIC treatment were significantly higher than those with progressive disease(PD)(P<0.05).In contrast,VWF:Ag/ADAMTS13:AC ratio and VEGF levels in HCC patients with SD+PR were significantly lower than those with PD(both P<0.05).Patients with high VWF:Ag/ADAMTS13:AC ratio(>2.7)had higher VEGF levels than those with low ratio(≤2.7).Multivariable analysis revealed that VWF:Ag/ADAMTS13:AC ratio was a predictive factor of HAIC treatment response.CONCLUSION VWF:Ag/ADAMTS13:AC ratio may become a useful biomarker of treatment response in HCC patients before the initiation of HAIC treatment.展开更多
In this single-arm,phase 2 study,we explored the efficacy and safety of hepatic arterial infusion chemotherapy(HAIC)combined with anlotinib and TQB2450(an anti-PD-L1 antibody)as a postoperative adjuvant treatment in p...In this single-arm,phase 2 study,we explored the efficacy and safety of hepatic arterial infusion chemotherapy(HAIC)combined with anlotinib and TQB2450(an anti-PD-L1 antibody)as a postoperative adjuvant treatment in patients at high risk of hepatocellular carcinoma(HCC)recurrence.Patients with high-risk recurrence of HCC were treated with HAIC,anlotinib(4 or 8 cycles),and TQB2450 after curative surgery.The primary endpoint was disease-free survival(DFS),and the secondary endpoints included overall survival(OS)and safety.77 patients who met the inclusion criteria were enrolled:38 in the 4-cycle cohort and 39 in the 8-cycle cohort.As of the data cutoff on June 24,2024,the median follow-up period was 21.19 months(95%confidence interval[CI],20.49–21.89).The median DFS and OS of all patients were not reached.1-year and 2-year DFS rates were 84.4%and 65.8%,respectively,while 1-year and 2-year OS rates were 96.1%and 89.8%,respectively.No significant differences in DFS and OS were observed in patients treated with 4 or 8 cycles of anlotinib.The incidence of grade 3/4 adverse events(AEs)was 28.6%.Postoperative adjuvant HAIC combined with anlotinib and TQB2450 demonstrated encouraging clinical benefits in reducing recurrence with manageable toxicities in patients at high risk of HCC recurrence.4-cycle anlotinib combined with HAIC and TQB2450 is recommended as an adjuvant treatment for further investigation.展开更多
在不可切除性肝细胞癌的治疗方式中,局部治疗联合系统治疗是目前的主要治疗方式,但目前尚无统一的方案。近年来,肝动脉灌注化疗(Hepatic Arterial Infusion Chemotherapy, HAIC)和肝动脉化疗栓塞(Transcatheter Arterial Chemoembolizat...在不可切除性肝细胞癌的治疗方式中,局部治疗联合系统治疗是目前的主要治疗方式,但目前尚无统一的方案。近年来,肝动脉灌注化疗(Hepatic Arterial Infusion Chemotherapy, HAIC)和肝动脉化疗栓塞(Transcatheter Arterial Chemoembolization, TACE)已成为不可切除性肝癌治疗的主要手段之一。通过回顾近年来的文献和研究,本综述总结了HAIC和TACE在不可切除性肝癌中的应用现状及进展,重点介绍了两种方法的治疗机制、临床疗效、并发症及其联合治疗的新模式。Among the treatment modalities for unresectable hepatocellular carcinoma, local therapy combined with systemic therapy is the main treatment modality at present, but there is no uniform protocol. In recent years, hepatic arterial infusion chemotherapy (HAIC) and transcatheter arterial chemoembolization (TACE) have become one of the main means of treatment for unresectable hepatocellular carcinoma. By reviewing the literature and studies in recent years, this review summarizes the current status and progress of the application of HAIC and TACE in unresectable hepatocellular carcinoma, focusing on the therapeutic mechanism, clinical efficacy, complications, and its new paradigm of combined treatment of the two approaches.展开更多
肝细胞癌作为比较常见的一种恶性肿瘤,其致死率非常高,目前大部分肝细胞癌患者到院就诊时已经处于中晚期,可进行手术治疗的病例非常少,预后效果不理想。目前肝动脉化疗栓塞术在肝细胞癌的临床中已经得到了广泛应用,且所获疗效也得到了...肝细胞癌作为比较常见的一种恶性肿瘤,其致死率非常高,目前大部分肝细胞癌患者到院就诊时已经处于中晚期,可进行手术治疗的病例非常少,预后效果不理想。目前肝动脉化疗栓塞术在肝细胞癌的临床中已经得到了广泛应用,且所获疗效也得到了认可。为进一步探讨分析加深对肝动脉化疗栓塞术的认识,本次研究就肝动脉化疗栓塞术联合治疗原发性肝癌的研究现状及进展进行综述,希望可为今后肝细胞癌患者治疗方案的明确提供可参考依据。Hepatocellular carcinoma (HCC) is a common malignant tumor, and its mortality rate is very high. At present, most patients with HCC are in the middle and late stages when they go to the hospital. There are very few cases of feasible surgical treatment, and the prognosis is not ideal. At present, transcatheter arterial chemoembolization has been widely used in the clinical treatment of hepatocellular carcinoma, and its efficacy has also been recognized. In order to further explore and deepen the understanding of transcatheter arterial chemoembolization, this study reviewed the research status and progress of transcatheter arterial chemoembolization in the treatment of primary liver cancer, hoping to provide a reference for the future treatment of patients with hepatocellular carcinoma.展开更多
文摘经肝动脉栓塞化疗(Transcatheter Arterial Chemoembolization, TACE)是目前全球范围内中晚期肝细胞肝癌(Hepatocellular Carcinoma, HCC)推荐的一线治疗方式,但由于中晚期HCC患者在肿瘤负荷和肝功能等方面存在较大的差异性,部分患者在接受多次TACE治疗后,靶病灶无法取得控制,为避免重复无效的TACE治疗影响患者肝功能及预后,TACE抵抗的概念被提出。当HCC患者发生TACE抵抗后,需及时终止TACE治疗而转换为其他治疗方式。在本篇综述中,主要探讨经肝动脉灌注化疗(Hepatic Artery Infusion Chemotherapy, HAIC)在治疗发生TACE抵抗的HCC患者中的价值。Transcatheter arterial chemoembolization (TACE) is currently the recommended first-line treatment for advanced hepatocyte carcinoma (HCC) worldwide. However, due to the significant heterogeneity in tumor burden and liver function among advanced HCC patients, some patients fail to control the target lesions after multiple TACE treatments. To avoid repetitive ineffective TACE treatments that may affect liver function and prognosis, the concept of TACE resistance has been proposed. Once HCC patients develop TACE resistance, TACE treatment should be promptly terminated and switched to other treatment modalities. In this review, the value of hepatic artery infusion chemotherapy (HAIC) in treating HCC patients with TACE resistance is mainly discussed.
文摘BACKGROUND Prediction of HAIC treatment response is important for improving the prognosis in patients with hepatocellular carcinoma(HCC).The progression of HCC is related to hypercoagulability and angiogenesis.It is known that ADAMTS13 and von Willebrand factor(VWF)are related to hypercoagulability.In addition,previous study reported that the association between ADAMTS13 and VWF,and angiogenesis via vascular endothelial growth factor(VEGF).Recently,ADAMTS13 and VWF have been associated with the prognosis in patients with various kinds of cancer undergoing chemotherapy.AIM To investigate whether ADAMTS13 and VWF become useful biomarkers of treatment response in HCC patients before the initiation of HAIC treatment.METHODS Seventy-two patients were enrolled in this study.ADAMTS13 activity(ADAMTS13:AC),VWF antigen(VWF:Ag)and VEGF levels were determined via enzyme-linked immunosorbent assay.Univariable and multivariable analyses were performed to determine the predictive factors of treatment response in patients with HCC undergoing HAIC treatment.RESULTS ADAMTS13:AC levels in HCC patients with stable disease(SD)+partial response(PR)of HAIC treatment were significantly higher than those with progressive disease(PD)(P<0.05).In contrast,VWF:Ag/ADAMTS13:AC ratio and VEGF levels in HCC patients with SD+PR were significantly lower than those with PD(both P<0.05).Patients with high VWF:Ag/ADAMTS13:AC ratio(>2.7)had higher VEGF levels than those with low ratio(≤2.7).Multivariable analysis revealed that VWF:Ag/ADAMTS13:AC ratio was a predictive factor of HAIC treatment response.CONCLUSION VWF:Ag/ADAMTS13:AC ratio may become a useful biomarker of treatment response in HCC patients before the initiation of HAIC treatment.
基金supported by the National Natural Science Foundation of China(82472956 and M-0334)the China Postdoctoral Science Foundation(BX20240082 and 2024M750536)+2 种基金the Shanghai Rising Star Program Sailing Project(24YF2705600 and 24YF2738200)the Shanghai Xuhui District Hospital Local Cooperation Project(23XHYD-20)the Shanghai Xuhui District Health Commission’s Joint Research Project on Key Diseases(XHLHGG202103).
文摘In this single-arm,phase 2 study,we explored the efficacy and safety of hepatic arterial infusion chemotherapy(HAIC)combined with anlotinib and TQB2450(an anti-PD-L1 antibody)as a postoperative adjuvant treatment in patients at high risk of hepatocellular carcinoma(HCC)recurrence.Patients with high-risk recurrence of HCC were treated with HAIC,anlotinib(4 or 8 cycles),and TQB2450 after curative surgery.The primary endpoint was disease-free survival(DFS),and the secondary endpoints included overall survival(OS)and safety.77 patients who met the inclusion criteria were enrolled:38 in the 4-cycle cohort and 39 in the 8-cycle cohort.As of the data cutoff on June 24,2024,the median follow-up period was 21.19 months(95%confidence interval[CI],20.49–21.89).The median DFS and OS of all patients were not reached.1-year and 2-year DFS rates were 84.4%and 65.8%,respectively,while 1-year and 2-year OS rates were 96.1%and 89.8%,respectively.No significant differences in DFS and OS were observed in patients treated with 4 or 8 cycles of anlotinib.The incidence of grade 3/4 adverse events(AEs)was 28.6%.Postoperative adjuvant HAIC combined with anlotinib and TQB2450 demonstrated encouraging clinical benefits in reducing recurrence with manageable toxicities in patients at high risk of HCC recurrence.4-cycle anlotinib combined with HAIC and TQB2450 is recommended as an adjuvant treatment for further investigation.
文摘在不可切除性肝细胞癌的治疗方式中,局部治疗联合系统治疗是目前的主要治疗方式,但目前尚无统一的方案。近年来,肝动脉灌注化疗(Hepatic Arterial Infusion Chemotherapy, HAIC)和肝动脉化疗栓塞(Transcatheter Arterial Chemoembolization, TACE)已成为不可切除性肝癌治疗的主要手段之一。通过回顾近年来的文献和研究,本综述总结了HAIC和TACE在不可切除性肝癌中的应用现状及进展,重点介绍了两种方法的治疗机制、临床疗效、并发症及其联合治疗的新模式。Among the treatment modalities for unresectable hepatocellular carcinoma, local therapy combined with systemic therapy is the main treatment modality at present, but there is no uniform protocol. In recent years, hepatic arterial infusion chemotherapy (HAIC) and transcatheter arterial chemoembolization (TACE) have become one of the main means of treatment for unresectable hepatocellular carcinoma. By reviewing the literature and studies in recent years, this review summarizes the current status and progress of the application of HAIC and TACE in unresectable hepatocellular carcinoma, focusing on the therapeutic mechanism, clinical efficacy, complications, and its new paradigm of combined treatment of the two approaches.
文摘肝细胞癌作为比较常见的一种恶性肿瘤,其致死率非常高,目前大部分肝细胞癌患者到院就诊时已经处于中晚期,可进行手术治疗的病例非常少,预后效果不理想。目前肝动脉化疗栓塞术在肝细胞癌的临床中已经得到了广泛应用,且所获疗效也得到了认可。为进一步探讨分析加深对肝动脉化疗栓塞术的认识,本次研究就肝动脉化疗栓塞术联合治疗原发性肝癌的研究现状及进展进行综述,希望可为今后肝细胞癌患者治疗方案的明确提供可参考依据。Hepatocellular carcinoma (HCC) is a common malignant tumor, and its mortality rate is very high. At present, most patients with HCC are in the middle and late stages when they go to the hospital. There are very few cases of feasible surgical treatment, and the prognosis is not ideal. At present, transcatheter arterial chemoembolization has been widely used in the clinical treatment of hepatocellular carcinoma, and its efficacy has also been recognized. In order to further explore and deepen the understanding of transcatheter arterial chemoembolization, this study reviewed the research status and progress of transcatheter arterial chemoembolization in the treatment of primary liver cancer, hoping to provide a reference for the future treatment of patients with hepatocellular carcinoma.
