Terashima Takeshi, Yamashita Tatsuya, Takata Noboru, Toyama Tadashi, Shimakami Tetsuro, Takatori Hajime, Arai Kuniaki, Kawaguchi Kazunori, Kitamura Kazuya, Yamashita Taro, Sakai Yoshio, Mizukoshi Eishiro, Honda Masao, Kaneko Shuichi
Department of Gastroenterology, Kanazawa University Hospital, Ishikawa, Japan.
Innovative Clinical Research Center, Kanazawa University, Ishikawa, Japan.
Hepatol Res. 2020 Jul;50(7):871-884. doi: 10.1111/hepr.13505. Epub 2020 May 15.
Most patients with advanced hepatocellular carcinoma (HCC) have underlying chronic liver disease, which potentially deteriorated the liver functional reserve that often affects the patients' clinical course. We investigated and compared the changes in liver functional reserve during lenvatinib or sorafenib therapy in patients with advanced HCC.
We prospectively collected medical information about patients with advanced HCC with a Child-Pugh score of 5-7 to compare the liver functional reserve during treatment in those who were treated with lenvatinib or sorafenib. We also evaluated the effect of the change in the liver functional reserve on patients' outcome. Moreover, we analyzed the contributing factors for maintaining the liver functional reserve during treatment.
Patients were treated with lenvatinib (n = 45) or sorafenib (n = 157). Forty-five patients in the lenvatinib group and 135 patients in the sorafenib group were selected through a propensity score matching analysis. More patients treated with lenvatinib had a Child-Pugh score that was maintained or improved after 4 and 12 weeks compared with those treated with sorafenib (P = 0.048, P = 0.036, respectively). Lenvatinib was identified as one of the variables that was associated with maintaining Child-Pugh scores. Multivariate analysis revealed that a worsened Child-Pugh score after 4 weeks was an independent unfavorable predictive factor for overall survival.
More patients treated with lenvatinib for advanced HCC maintained their liver functional reserves compared with those treated with sorafenib. Maintaining the liver functional reserve contributed to better outcomes for patients with advanced HCC.
大多数晚期肝细胞癌（HCC）患者存在潜在的慢性肝病，这可能会使肝脏功能储备恶化，进而常常影响患者的临床病程。我们研究并比较了晚期HCC患者在接受乐伐替尼或索拉非尼治疗期间肝脏功能储备的变化。
我们前瞻性收集了Child-Pugh评分为5-7分的晚期HCC患者的医疗信息，以比较接受乐伐替尼或索拉非尼治疗的患者在治疗期间的肝脏功能储备。我们还评估了肝脏功能储备变化对患者预后的影响。此外，我们分析了治疗期间维持肝脏功能储备的相关因素。
患者接受乐伐替尼治疗（n = 45）或索拉非尼治疗（n = 157）。通过倾向评分匹配分析，从乐伐替尼组中选取了45例患者，从索拉非尼组中选取了135例患者。与接受索拉非尼治疗的患者相比，接受乐伐替尼治疗的更多患者在4周和12周后Child-Pugh评分维持不变或有所改善（分别为P = 0.048，P = 0.036）。乐伐替尼被确定为与维持Child-Pugh评分相关的变量之一。多因素分析显示，4周后Child-Pugh评分恶化是总生存的独立不良预测因素。
与接受索拉非尼治疗的晚期HCC患者相比，接受乐伐替尼治疗的更多患者维持了其肝脏功能储备。维持肝脏功能储备有助于晚期HCC患者获得更好的预后。
