Perng Pang-Shuo, Lai Yu-Hsuan, Lee Po-Hsuan, Huang Chi-Chen, Hsu Hao-Hsiang, Lee Jung-Shun
Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
J Clin Med. 2022 Mar 11;11(6):1536. doi: 10.3390/jcm11061536.
Surgery or whole-brain radiotherapy (WBRT) for the management of brain metastasis of hepatocellular carcinoma (HCC) is associated with improved survival. However, the efficacy of multi-tyrosine kinase inhibitors (TKIs) and possible bleeding complications have not been studied in these patients. Therefore, this study aimed at investigating TKI safety and efficacy in these patients. We retrospectively reviewed 39 patients who underwent surgery or WBRT for brain metastasis of HCC. Intracranial tumor bleeding rates were compared between patients who did and did not receive TKIs. Survival outcomes were analyzed using the log-rank and Cox regression tests. A total of 22 and 7 patients received sorafenib and lenvatinib, respectively. The intracranial tumor bleeding rates were 61.5% and 70% in patients who did and did not receive TKIs, respectively (p > 0.99). Survival analysis revealed craniotomy (adjusted odds ratio [AOR]: 0.45, p = 0.04), a higher Karnofsky Performance Score (AOR: 0.97, p < 0.01), and TKI use (AOR: 0.26, p < 0.01) were positive prognostic factors for overall survival. TKIs were associated with better survival outcomes in patients who underwent surgery or WBRT for brain metastasis of HCC and did not increase intracranial bleeding. Therefore, TKIs are efficacious and safe for treating brain metastasis of HCC.
手术或全脑放疗（WBRT）用于治疗肝细胞癌（HCC）脑转移可提高生存率。然而，多酪氨酸激酶抑制剂（TKIs）的疗效及可能的出血并发症在这些患者中尚未得到研究。因此，本研究旨在调查TKIs在这些患者中的安全性和疗效。我们回顾性分析了39例行手术或WBRT治疗HCC脑转移的患者。比较接受和未接受TKIs患者的颅内肿瘤出血率。使用对数秩检验和Cox回归检验分析生存结果。分别有22例和7例患者接受了索拉非尼和乐伐替尼治疗。接受和未接受TKIs患者的颅内肿瘤出血率分别为61.5%和70%（p>0.99）。生存分析显示开颅手术（调整优势比[AOR]：0.45，p=0.04）、较高的卡诺夫斯基表现评分（AOR：0.97，p<0.01）和使用TKIs（AOR：0.26，p<0.01）是总生存的阳性预后因素。对于接受手术或WBRT治疗HCC脑转移的患者，TKIs与更好的生存结果相关，且不会增加颅内出血。因此，TKIs治疗HCC脑转移有效且安全。
