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Hu Y, Pan T, Cai X, He QS, Zheng YB, Huang MS, Jiang ZB, Chen JW, Wu C. Addition of transarterial chemoembolization improves outcome of tyrosine kinase and immune checkpoint inhibitors regime in patients with unresectable hepatocellular carcinoma. J Gastrointest Oncol 2023; 14:1837-1848. [PMID: 37720446 PMCID: PMC10502547 DOI: 10.21037/jgo-23-486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/01/2023] [Indexed: 09/19/2023] Open
Abstract
Background Transarterial chemoembolization (TACE) is the standard treatment for hepatocellular carcinoma (HCC); the value of its combination with systemic therapy is worthy of further exploration. This study aimed to investigate the efficacy and safety of TACE combined with tyrosine kinase inhibitor (TKI) and immune checkpoint inhibitor (ICI) in the treatment of unresectable HCC. Methods In this retrospective observational, single-center study, 147 patients with unresectable HCC were divided into a TACE group (n=98) and a non-TACE group (n=49) based on whether TACE was performed during TKI plus ICI therapy. The survival outcomes and adverse events (AEs) of the two groups were compared. Results Data from patients with unresectable HCC who received TKI plus ICI treatment between July 2017 and April 2020 were collected. The median intrahepatic tumor size was 8.7 cm [interquartile range (IQR), 5.9-12.4 cm]. At data cut-off, overall survival (OS) of the TACE group was significantly longer than that of the non-TACE group (19.5 and 10.8 months, respectively, P=0.005). In the high-risk cohort (with main or contralateral portal vein tumor thrombi and/or bile duct invasion and/or a tumor burden >50% of liver), the OS of the TACE group was still longer than that of the non-TACE group (14.9 and 8.7 months, respectively, P=0.031). Major AEs were tolerated in both groups, and there was no significant difference in their incidence (34.7% and 30.6%, respectively, P=0.621). Conclusions TACE treatment combined with TKI plus ICI regime resulted in longer OS than treatment with TKI plus ICI alone for patients with unresectable HCC.
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Affiliation(s)
- Yue Hu
- Department of Interventional Radiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Tao Pan
- Department of Interventional Radiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xi Cai
- Department of Interventional Radiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Quan-Sheng He
- Department of Interventional Radiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu-Bao Zheng
- Department of Infectious Diseases, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ming-Sheng Huang
- Department of Interventional Radiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zai-Bo Jiang
- Department of Interventional Radiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun-Wei Chen
- Department of Interventional Radiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chun Wu
- Department of Interventional Radiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Ding XW, Zheng ZC, Zhao Q, Zhai G, Liang H, Wu X, Zhu ZG, Wang HJ, He QS, He XL, Du YA, Chen LC, Hua YW, Huang CM, Xue YW, Zhou Y, Zhou YB, Wu D, Fang XD, Dai YG, Zhang HW, Cao JQ, Li LP, Chai J, Tao KX, Li GL, Jie ZG, Ge J, Xu ZF, Zhang WB, Li QY, Zhao P, Ma ZQ, Yan ZL, Zheng GL, Yan Y, Tang XL, Zhou X. [A multi-center retrospective study of perioperative chemotherapy for gastric cancer based on real-world data]. Zhonghua Wei Chang Wai Ke Za Zhi 2021; 24:403-412. [PMID: 34000769 DOI: 10.3760/cma.j.cn.441530-20200111-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the effect of perioperative chemotherapy on the prognosis of gastric cancer patients under real-world condition. Methods: A retrospective cohort study was carried out. Real world data of gastric cancer patients receiving perioperative chemotherapy and surgery + adjuvant chemotherapy in 33 domestic hospitals from January 1, 2014 to January 31, 2016 were collected. Inclusion criteria: (1) gastric adenocarcinoma was confirmed by histopathology, and clinical stage was cT2-4aN0-3M0 (AJCC 8th edition); (2) D2 radical gastric cancer surgery was performed; (3) at least one cycle of neoadjuvant chemotherapy (NAC) was completed; (4) at least 4 cycles of adjuvant chemotherapy (AC) [SOX (S-1+oxaliplatin) or CapeOX (capecitabine + oxaliplatin)] were completed. Exclusion criteria: (1) complicated with other malignant tumors; (2) radiotherapy received; (3) patients with incomplete data. The enrolled patients who received neoadjuvant chemotherapy and adjuvant chemotherapy were included in the perioperative chemotherapy group, and those who received only postoperative adjuvant chemotherapy were included in the surgery + adjuvant chemotherapy group. Propensity score matching (PSM) method was used to control selection bias. The primary outcome were overall survival (OS) and progression-free survival (PFS) after PSM. OS was defined as the time from the first neoadjuvant chemotherapy (operation + adjuvant chemotherapy group: from the date of operation) to the last effective follow-up or death. PFS was defined as the time from the first neoadjuvant chemotherapy (operation + adjuvant chemotherapy group: from the date of operation) to the first imaging diagnosis of tumor progression or death. The Kaplan-Meier method was used to estimate the survival rate, and the Cox proportional hazards model was used to evaluate the independent effect of perioperative chemo therapy on OS and PFS. Results: 2 045 cases were included, including 1 293 cases in the surgery+adjuvant chemotherapy group and 752 cases in the perioperative chemotherapy group. After PSM, 492 pairs were included in the analysis. There were no statistically significant differences in gender, age, body mass index, tumor stage before treatment, and tumor location between the two groups (all P>0.05). Compared with the surgery + adjuvant chemotherapy group, patients in the perioperative chemotherapy group had higher proportion of total gastrectomy (χ(2)=40.526, P<0.001), smaller maximum tumor diameter (t=3.969, P<0.001), less number of metastatic lymph nodes (t=1.343, P<0.001), lower ratio of vessel invasion (χ(2)=11.897, P=0.001) and nerve invasion (χ(2)=12.338, P<0.001). In the perioperative chemotherapy group and surgery + adjuvant chemotherapy group, 24 cases (4.9%) and 17 cases (3.4%) developed postoperative complications, respectively, and no significant difference was found between two groups (χ(2)=0.815, P=0.367). The median OS of the perioperative chemotherapy group was longer than that of the surgery + adjuvant chemotherapy group (65 months vs. 45 months, HR: 0.74, 95% CI: 0.62-0.89, P=0.001); the median PFS of the perioperative chemotherapy group was also longer than that of the surgery+adjuvant chemotherapy group (56 months vs. 36 months, HR=0.72, 95% CI:0.61-0.85, P<0.001). The forest plot results of subgroup analysis showed that both men and women could benefit from perioperative chemotherapy (all P<0.05); patients over 45 years of age (P<0.05) and with normal body mass (P<0.01) could benefit significantly; patients with cTNM stage II and III presented a trend of benefit or could benefit significantly (P<0.05); patients with signet ring cell carcinoma benefited little (P>0.05); tumors in the gastric body and gastric antrum benefited more significantly (P<0.05). Conclusion: Perioperative chemotherapy can improve the prognosis of gastric cancer patients.
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Affiliation(s)
- X W Ding
- Department of Gastric surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer Prevention and Therapy, Tianjin 300060, China
| | - Z C Zheng
- Department of Gastric Surgery, Cancer Hospital of China Medical University (Liaoning Cancer Hospital and Institute), Shenyang 110042, China
| | - Q Zhao
- The Third Department of Surgery, The Fourth Hospital, Hebei Medical University, Shijiazhuang 050011, China
| | - G Zhai
- Department of General Surgery, Shanxi Provincial Tumor Hospital, Taiyuan 030013, China
| | - H Liang
- Department of Gastric surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer Prevention and Therapy, Tianjin 300060, China
| | - X Wu
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Z G Zhu
- Department of Surgery, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai Institute of Digestive Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai 200025, China
| | - H J Wang
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi 830011, China
| | - Q S He
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, China
| | - X L He
- Department of General Surgery, Tangdu Hospital, The Air Force Medical University, Xi'an 710038, China
| | - Y A Du
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - L C Chen
- Department of Gastrointestinal Surgery, Fujian Provincial Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, China
| | - Y W Hua
- Department of General Surgery, The Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - C M Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350004, China
| | - Y W Xue
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - Y Zhou
- Department of Gastic Surgery, Afiliated CancerHospital, Fudan University, Shanghai 200030, China
| | - Y B Zhou
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - D Wu
- Department of Gastrointestinal Surgery, Second Affiliated Hospital, Zhejiang University, Hangzhou 310009, China
| | - X D Fang
- Department of Gastrointestinal Colorectal And Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, China
| | - Y G Dai
- Department of Gastrointestinal Surgery, Yunnan Cancer Hospital, Kunming 650118, China
| | - H W Zhang
- Diagnosis and Treatment Center of Digestive Disease, Wuxi Mingci cardiovascular Hospital, Wuxi 214101, China
| | - J Q Cao
- Department of Gastrointestinal Surgery, Second Affiliated Hospital, Nanchang University, Nanchang 330006, China
| | - L P Li
- Department of Gastrointestinal Surgery, The Affiliated Provincial Hospital, Shandong First Medical University, Jinan 250021, China
| | - J Chai
- Department of Gastric Surgery, The Affiliated Shandong Tumor Hospital, Shandong University, Jinan 250117, China
| | - K X Tao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - G L Li
- Department of General Surgery, Jinling Hospital/General Hospital of Eastern Theater Command, School of Medicine, Nanjing University, Nanjing 210002, China
| | - Z G Jie
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - J Ge
- Department of Gastrointestinal Surgery Xiangya Hospital of Central South University, Changsha 410008, China
| | - Z F Xu
- Department of General Surgery, The Affiliated Hospital, Shandong Academy of Medical Sciences, Jinan 250031, China
| | - W B Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, China
| | - Q Y Li
- Departerment of Abdominal Surgery, Jiangxi Cancer Hospital, Nanchang 330029, China
| | - P Zhao
- Departerment of Gastrointestinal Surgery, Sichuan Tumor Hospital, Chengdu 610041, China
| | - Z Q Ma
- Department of General Surgery, Peking Uninon Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences (CAMS) and PUMC, Beijing 100730, China
| | - Z L Yan
- Department of Gastrointestinal Surgery, Ningbo First Hospital, Ningbo 315000, China
| | - G L Zheng
- Department of Gastric surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer Prevention and Therapy, Tianjin 300060, China
| | - Y Yan
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - X L Tang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, China
| | - X Zhou
- The Third Department of Surgery, The Fourth Hospital, Hebei Medical University, Shijiazhuang 050011, China
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He QS, Yang LF, Wang WB, Yuan B, Zhang LY, Guo XJ. Vascular endothelial growth factor gene is associated with hypertensive cerebellar hemorrhage and rehabilitative treatment. Genet Mol Res 2015; 14:9849-57. [PMID: 26345918 DOI: 10.4238/2015.august.19.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Early rehabilitative therapy is important for patients with hypertensive cerebral hemorrhage to improve long-term function of the extremities. Vascular endothelial growth factor (VEGF) is closely associated with the pathogenesis of hypertension. To identify the markers contributing to the genetic susceptibility to hypertensive cerebellar hemorrhage (HCH) and rehabilitative treatment, we examined the potential association between HCH and 12 single nucleotide polymorphisms of the VEGF gene. Participants included 244 patients with HCH and 251 healthy controls from our rehabilitation department. The T allelic frequencies of the rs3025020 (intron 6) and rs3025039 (3'-UTR) polymorphisms were significantly higher in the patients with HCH than in the healthy controls (rs3025020 T allele: P = 0.0002, OR = 1.619, 95%CI = 1.256-2.088; rs3025039 T allele: P = 0.001, OR = 1.682, 95%CI = 1.246-2.270). Strong linkage disequilibrium was observed in three blocks (D' > 0.9), and significantly more C-G-C (rs3025020, rs3025030, and rs3025039) haplotypes (P = 0.001) were found in the controls in block 3. Significantly more T-G-C haplotypes were found in the patients with HCH (P = 0.046). Further genotype and clinical phenotype correlation study of the rs3025039 carriers showed that Fugl-Meyer and Barthel index scores were lower in the patients with the TT genotype relative to CT + CC genotypes (P < 0.01). These findings point to a role for VEGF polymorphism in HCH, and may be informative for future investigations on the pathogenesis of rehabilitative treatment.
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Affiliation(s)
- Q S He
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Xinxiang Medical University
| | - L F Yang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Xinxiang Medical University
| | - W B Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Xinxiang Medical University
| | - B Yuan
- Department of Internal Neurology, The First Affiliated Hospital of Xinxiang Medical University
| | - L Y Zhang
- Department of Rheumatology Nephropathy, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
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