Kaneko Shun, Tsuchiya Kaoru, Yasui Yutaka, Tanaka Yuki, Inada Kento, Ishido Shun, Kirino Sakura, Yamashita Koji, Hayakawa Yuka, Nobusawa Tsubasa, Matsumoto Hiroaki, Kakegawa Tatsuya, Higuchi Mayu, Takaura Kenta, Tanaka Shohei, Maeyashiki Chiaki, Tamaki Nobuharu, Takahashi Yuka, Nakanishi Hiroyuki, Irie Takumi, Ariizumi Shun-Ichi, Kurosaki Masayuki, Izumi Namiki
Department of Gastroenterology and Hepatology Musashino Red Cross Hospital Tokyo Japan.
Department of Surgery Musashino Red Cross Hospital Tokyo Japan.
JGH Open. 2022 Apr 21;6(5):301-308. doi: 10.1002/jgh3.12735. eCollection 2022 May.
Conversion surgery (CS), which aims to cure after systematic therapy, is only scarcely reported in the field of hepatocellular carcinoma (HCC). However, advancements in systemic therapy for HCC are expected to increase the candidates eligible for CS because of the higher response rate. The aim of this study was to clarify the characteristics of patients who underwent CS after tyrosine kinase inhibitor (TKI) therapy.
In all, 364 patients who were treated with first-line sorafenib (SOR; = 292) and lenvatinib (LEN; = 72) from July 2009 to October 2020 were retrospectively enrolled. The endpoint of this analysis was overall survival (OS), and factors associated with CS are revealed.
Six patients underwent CS after TKI therapy, and of these four (1.4%) and two (2.7%) patients received SOR and LEN, respectively. At baseline, patients who underwent CS were significantly younger (median 52 [range, 46-83] years of age, = 0.019), and their etiology included viral hepatitis, especially hepatitis B virus (HBV) ( = 0.049). Improvements or maintenance of preoperative modified albumin-bilirubin grade from baseline were observed in five (83.3%) patients, and partial radiologic response was observed in four (66.7%) patients. The median OS and 3-year survival rate of patients treated with CS were "not reached" and 80.0%, respectively.
The patients who underwent CS after TKI therapy for HCC experienced long survival, were relatively young, and exhibited radiologic response to TKIs, and their liver function was either maintained or improved. Therefore, CS may lead to a better prognosis in patients with advanced HCC.
旨在进行系统治疗后实现治愈的转化性手术（CS）在肝细胞癌（HCC）领域报道极少。然而，由于HCC系统治疗的进展，更高的缓解率有望增加适合CS的患者。本研究的目的是阐明酪氨酸激酶抑制剂（TKI）治疗后接受CS患者的特征。
回顾性纳入2009年7月至2020年10月期间接受一线索拉非尼（SOR；n = 292）和仑伐替尼（LEN；n = 72）治疗的364例患者。该分析的终点是总生存期（OS），并揭示与CS相关的因素。
6例患者在TKI治疗后接受了CS，其中4例（1.4%）和2例（2.7%）患者分别接受了SOR和LEN。基线时，接受CS的患者明显更年轻（中位年龄52岁[范围，46 - 83岁]，P = 0.019），其病因包括病毒性肝炎，尤其是乙型肝炎病毒（HBV）（P = 0.049）。5例（83.3%）患者术前改良白蛋白 - 胆红素分级从基线得到改善或维持，4例（66.7%）患者观察到部分影像学缓解。接受CS治疗的患者的中位OS和3年生存率分别为“未达到”和80.0%。
HCC患者在TKI治疗后接受CS，生存期长，相对年轻，对TKI有影像学反应，且肝功能维持或改善。因此，CS可能使晚期HCC患者预后更好。
