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Increased Liquefactive Necrosis Formation After Transarterial Chemoembolization Combined with Molecular Targeted Agents Plus Immune Checkpoint Inhibitors for Hepatocellular Carcinoma
Cancer Management and Research ( IF 2.5 ) Pub Date : 2021-09-07 , DOI: 10.2147/cmar.s328812 Yingliang Wang 1, 2 , Chen Zhou 1, 2 , Jiacheng Liu 1, 2 , Qin Shi 1, 2 , Songjiang Huang 1, 2 , Chongtu Yang 1, 2 , Tongqiang Li 1, 2 , Yang Chen 1, 2 , Bin Xiong 1, 2
Cancer Management and Research ( IF 2.5 ) Pub Date : 2021-09-07 , DOI: 10.2147/cmar.s328812 Yingliang Wang 1, 2 , Chen Zhou 1, 2 , Jiacheng Liu 1, 2 , Qin Shi 1, 2 , Songjiang Huang 1, 2 , Chongtu Yang 1, 2 , Tongqiang Li 1, 2 , Yang Chen 1, 2 , Bin Xiong 1, 2
Affiliation
Purpose: In clinical practice, we found some of the patients who received transarterial chemoembolization (TACE) with molecular targeted agents (MTGs) plus immune checkpoint inhibitors (ICIs) for hepatocellular carcinoma (HCC) had obvious liquefactive necrosis formation within the tumor and some even progressed to a liver abscess, which seems more frequent than patients who received other treatments. Thus, we aim to identify this condition and analyze the potential risk factors.
Patients and Methods: Medical records of 72 consecutive patients with intermediate (BCLC B) and advanced (BCLC C) HCC who received TACE plus MTGs combined with (n=30) or without (n=42) ICIs were reviewed. Liquefactive necrosis formation was defined as the presence of obvious liquefactive necrosis within the tumor that required intervention.
Results: The liquefactive necrosis rate was higher in the TACE+MTGs+ICIs group than in the TACE+MTGs group (30% vs 4.8%, P=0.006). Moreover, 18.2% (2/11) of the patients with liquefactive necrosis within the tumor had a bacterial infection. We then take the binary logistic regression analysis model to identify the predictors of liquefactive necrosis formation, and which showed the tumor size (P=0.006, OR=1.355, 95% CI: 1.090– 1.684), alpha-fetoprotein level (P=0.036, OR=6.745, 95% CI: 1.130– 40.262) and treatment modality (P=0.015, OR=11.717, 95% CI: 1.617– 84.887) were the independent risk factor for liquefactive necrosis formation within the tumor.
Conclusion: Patients with HCC who received TACE combined with MTGs plus ICIs have increased liquefactive necrosis formation, and the larger tumor size and higher alpha-fetoprotein level were associated with more liquefactive necrosis formation within the tumor.
Keywords: liver cancer, transarterial chemoembolization, molecular targeted agents, immune checkpoint inhibitors, liquefactive necrosis
中文翻译：
肝细胞癌经动脉化疗栓塞联合分子靶向药物加免疫检查点抑制剂后液化坏死形成增加
目的：我们在临床实践中发现，部分接受分子靶向药物（MTG）联合免疫检查点抑制剂（ICIs）治疗肝细胞癌（HCC）的肝动脉化疗栓塞（TACE）患者肿瘤内出现明显的液化坏死形成，有的甚至出现了明显的液化坏死。进展为肝脓肿，这似乎比接受其他治疗的患者更常见。因此，我们的目标是识别这种情况并分析潜在的风险因素。
患者和方法：对72 名连续接受 TACE 加 MTG 联合 (n=30) 或不联合 (n=42) ICI 的中度 (BCLC B) 和晚期 (BCLC C) HCC 患者的医疗记录进行了审查。液化坏死形成定义为肿瘤内存在需要干预的明显液化坏死。
结果： TACE+MTGs+ICIs组液化坏死率高于TACE+MTGs组（30% vs 4.8%，P=0.006）。此外，18.2%（2/11）肿瘤内液化坏死的患者有细菌感染。然后，我们采用二元逻辑回归分析模型来识别液化坏死形成的预测因子，其中显示肿瘤大小（P=0.006，OR=1.355，95% CI：1.090–1.684）、甲胎蛋白水平（P=0.036） ，OR=6.745，95% CI：1.130–40.262）和治疗方式（P=0.015，OR=11.717，95% CI：1.617–84.887）是肿瘤内液化坏死形成的独立危险因素。
结论：接受 TACE 联合 MTGs 加 ICI 的 HCC 患者液化坏死形成增多，肿瘤体积越大、甲胎蛋白水平越高，肿瘤内液化坏死形成越多。
Keywords:肝癌, 经动脉化疗栓塞术, 分子靶向药物, 免疫检查点抑制剂, 液化坏死
更新日期：2021-09-06
Patients and Methods: Medical records of 72 consecutive patients with intermediate (BCLC B) and advanced (BCLC C) HCC who received TACE plus MTGs combined with (n=30) or without (n=42) ICIs were reviewed. Liquefactive necrosis formation was defined as the presence of obvious liquefactive necrosis within the tumor that required intervention.
Results: The liquefactive necrosis rate was higher in the TACE+MTGs+ICIs group than in the TACE+MTGs group (30% vs 4.8%, P=0.006). Moreover, 18.2% (2/11) of the patients with liquefactive necrosis within the tumor had a bacterial infection. We then take the binary logistic regression analysis model to identify the predictors of liquefactive necrosis formation, and which showed the tumor size (P=0.006, OR=1.355, 95% CI: 1.090– 1.684), alpha-fetoprotein level (P=0.036, OR=6.745, 95% CI: 1.130– 40.262) and treatment modality (P=0.015, OR=11.717, 95% CI: 1.617– 84.887) were the independent risk factor for liquefactive necrosis formation within the tumor.
Conclusion: Patients with HCC who received TACE combined with MTGs plus ICIs have increased liquefactive necrosis formation, and the larger tumor size and higher alpha-fetoprotein level were associated with more liquefactive necrosis formation within the tumor.
Keywords: liver cancer, transarterial chemoembolization, molecular targeted agents, immune checkpoint inhibitors, liquefactive necrosis
中文翻译：
肝细胞癌经动脉化疗栓塞联合分子靶向药物加免疫检查点抑制剂后液化坏死形成增加
目的：我们在临床实践中发现，部分接受分子靶向药物（MTG）联合免疫检查点抑制剂（ICIs）治疗肝细胞癌（HCC）的肝动脉化疗栓塞（TACE）患者肿瘤内出现明显的液化坏死形成，有的甚至出现了明显的液化坏死。进展为肝脓肿，这似乎比接受其他治疗的患者更常见。因此，我们的目标是识别这种情况并分析潜在的风险因素。
患者和方法：对72 名连续接受 TACE 加 MTG 联合 (n=30) 或不联合 (n=42) ICI 的中度 (BCLC B) 和晚期 (BCLC C) HCC 患者的医疗记录进行了审查。液化坏死形成定义为肿瘤内存在需要干预的明显液化坏死。
结果： TACE+MTGs+ICIs组液化坏死率高于TACE+MTGs组（30% vs 4.8%，P=0.006）。此外，18.2%（2/11）肿瘤内液化坏死的患者有细菌感染。然后，我们采用二元逻辑回归分析模型来识别液化坏死形成的预测因子，其中显示肿瘤大小（P=0.006，OR=1.355，95% CI：1.090–1.684）、甲胎蛋白水平（P=0.036） ，OR=6.745，95% CI：1.130–40.262）和治疗方式（P=0.015，OR=11.717，95% CI：1.617–84.887）是肿瘤内液化坏死形成的独立危险因素。
结论：接受 TACE 联合 MTGs 加 ICI 的 HCC 患者液化坏死形成增多，肿瘤体积越大、甲胎蛋白水平越高，肿瘤内液化坏死形成越多。
Keywords:肝癌, 经动脉化疗栓塞术, 分子靶向药物, 免疫检查点抑制剂, 液化坏死
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