Multicenter, retrospective GUIDANCE001 study comparing transarterial chemoembolization with or without tyrosine kinase and immune checkpoint inhibitors as conversion therapy to treat unresectable hepatocellular carcinoma: Survival benefit in intermediate or advanced, but not early, stages

作者：Da-Long Yang, Lin Ye, Fan-Jian Zeng, Jie Liu, Hongbing Yao, Jun-Liang Nong, Shaoping Liu, Ning Peng, Wenfeng Li, Pei‐Sheng Wu, Chuang Qin, Ze Su, Jun‐Jie Ou, Xiaofeng Dong, Yi-He Yan, Teng-Meng Zhong, X H Mao, Ming-Song Wu, Yao-Zhi Chen, Guo-Dong Wang, Mian-Jing Li, Xueyao Wang, Fuquan Yang, Yong-Rong Liang, Shuchang Chen, Yong‐Yu Yang, Kang Chen, Fu-Xin Li, Yongrong Lai, Qingqing Pang, Xiumei Liang, Xue‐Mei You, Bang‐De Xiang, Yaqun Yu, Liang Ma, Jian‐Hong Zhong, on behalf of the GUIDANCE investigators · 发表于：Hepatology · 年份：2025 · DOI：10.1097/hep.0000000000001229 · 被引用次数：27 · 研究领域：Hepatocellular Carcinoma Treatment and Prognosis、Cholangiocarcinoma and Gallbladder Cancer Studies、Organ Transplantation Techniques and Outcomes

BACKGROUND AND AIMS: Various conversion therapy options have become available to patients with unresectable HCC, but which conversion therapy is optimal for which type of patient is controversial. This study compared the efficacy and safety of TACE alone or combined with immune checkpoint and tyrosine kinase inhibitors. APPROACH AND RESULTS: Data were retrospectively compared for patients with initially unresectable HCC who underwent conversion therapy consisting of TACE alone (n=459) or combined with immune checkpoint and tyrosine kinase inhibitors (n=343). Compared to the group that received TACE alone, the group that received triple conversion therapy showed significantly higher rates of overall survival (HR 0.43, 95%CI 0.35-0.53). In addition, triple therapy was associated with significantly longer median progression-free survival (15.9 vs. 8.0 mo, p <0.001). These results were confirmed in matched subsets of patients from each group. However, subgroup analysis confirmed the results only for patients with HCC in intermediate or advanced stages, not in an early stage. Those who received triple conversion therapy had a significantly higher rate of hepatectomy after conversion therapy (36.4 vs. 23.5%, p <0.001). Among those who underwent hepatectomy after conversion therapy, triple therapy was associated with a significantly higher rate of complete tumor response (32.1 vs. 11.1%, p <0.001). However, it was also associated with a significantly higher frequency of serious adve...