2248 - Comparative Effectiveness and Safety of Systemic Therapy Plus Interventional Therapy with or without Radiotherapy in CNLC Stage IIIA Hepatocellular Carcinoma: A Retrospective Study
Presenter(s)
J. Wang1,2, Y. Wang3, J. Liu3, J. Yuan1, F. Wang1, Z. Zhang1, B. Tian1, Y. Xu1, S. Bao1, C. Tian1, J. Yu1, J. Zhang4, and D. Chen1; 1Shandong Provincial Key Laboratory of Precision Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China, 2School of Clinical Medicine,Shandong Second Medical University, Weifang, China, 3Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China, 4Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
Purpose/Objective(s): Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in China. Patients with China Liver Cancer (CNLC) stage IIIA usually have lost the opportunity for surgery. However, the efficacy of systemic therapy alone is limited, and the combination of local therapy, such as interventional therapy or radiotherapy, may improve the prognosis. The aim of this study is to compare the efficacy and safety of combined interventional therapy (TACE/HAIC) and radiotherapy in patients with CNLC stage IIIA HCC during systemic treatment, so as to provide a basis for clinical decision-making.
Materials/Methods:
Patients with CNLC stage IIIA HCC who received immunotherapy or targeted therapy from January 2019 to March 2025 were retrospectively enrolled in the intervention group (n=120) and the intervention combined with radiotherapy group (n=39). The primary endpoint was overall survival (OS). Secondary endpoints included progression-free survival (PFS) and safety analysis (AEs). Kaplan-Meier method was used to analyze the survival difference, and Cox regression model was used to evaluate the influencing factors.Results:
A total of 159 patients with CNLC stage IIIA HCC were enrolled in this study. According to whether the intervention was combined with radiotherapy, they were divided into the Intervention group (n=120) and the Intervention plus Radiotherapy group (n=39). For brevity, the latter is referred to as the Combination group. There were no significant differences in PFS (P=0.66) and OS (P=0.194) between the interventional group and the combination group. Multivariate Cox regression analysis showed that AFP (HR = 1.585, 95% CI: 1.070-2.348, P = 0.022) and liver function (HR = 2.142, 95% CI: 1.407-3.263, P < 0.001) were independent risk factors for PFS in patients with CNLC stage IIIA HCC. And gender (HR = 0.383, 95% CI: 0.201-0.733, P = 0.004) and liver function (HR = 4.745, 95% CI: 2.858-7.878, P < 0.001) were identified as independent factors for OS. In the intervention group, drug-induced liver injury occurred in 19 cases, accounting for 15.8%, 7 cases of abdominal discomfort, accounting for 5.8%, 11 cases (9.2%) had bone marrow suppression, and 6 cases (5%) of ascites. In the combination group, drug-induced liver injury occurred in 10 cases, accounting for 33.3%, 4 cases of abdominal discomfort, accounting for 10.3%, 5 cases of bone marrow suppression, accounting for 12.8%. No statistically significant differences in the incidence of adverse reactions were observed between the two groups.Conclusion:
For patients with CNLC stage IIIA HCC, combining radiotherapy with interventional therapy did not confer a significant survival advantage. Systemic therapy combined with interventional therapy is still the first choice for local intensive treatment, and poor liver function will increase the risk of disease progression or death. Further randomized controlled trials (RCTs) are needed to explore the best combination treatment strategy.