Department of Liver Surgery and Transplantation, Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Hepatic Oncology, Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, China.
Ann Surg Oncol. 2023 May;30(5):2782-2790. doi: 10.1245/s10434-022-12530-z. Epub 2022 Sep 30.
Combined treatment with tyrosine kinase inhibitors (TKI) plus anti-PD-1 antibodies showed high anti-tumor efficacy and made conversion resection possible for patients with unresectable hepatocellular carcinoma (HCC). However, long-term survival has not been reported.
A cohort of consecutive patients who received combined TKI/anti-PD-1 antibodies as first-line treatment for initially unresectable HCC at the authors' hospital between August 2018 and September 2020 was eligible for this study. Patients who were responding to systemic therapy and met the criteria for hepatectomy underwent liver resection with curative intention. The study also investigated the association of clinical factors with successful conversion resection and postoperative recurrence.
The study enrolled 101 patients including 24 patients (23.8 %) who underwent R0 resection a median of 3.9 months (interquartile range: 2.5-5.9 months) after initiation of systemic therapy. Patients with an Eastern cooperative oncology group performance status of 0, fewer intrahepatic tumors, or a radiographic response to systemic therapy were more likely to be able to receive curative resection. After a median follow-up period of 21.5 months, hepatectomy was independently associated with a favorable overall survival (hazard ratio [HR], 0.050; 95 % confidence interval [CI], 0.007-0.365; P = 0.003). For the 24 patients who underwent surgery, the 12-month recurrence-free survival and overall survival rates were respectively 75% and 95.8%. Achieving a pathologic complete response (n = 10) to systemic therapy was associated with a favorable recurrence-free survival after resection, with a trend toward significance (HR, 0.345; 95% CI, 0.067-1.785; P = 0.187).
Selected patients with initially unresectable HCC can undergo hepatectomy after systemic therapy with combined TKI/anti-PD-1 antibodies. In this study, conversion resection was associated with a favorable prognosis.
联合使用酪氨酸激酶抑制剂（TKI）和抗 PD-1 抗体治疗不可切除的肝细胞癌（HCC）患者显示出较高的抗肿瘤疗效，并使转化性切除术成为可能。然而，目前尚无长期生存的报道。
本研究纳入了 2018 年 8 月至 2020 年 9 月期间在作者医院接受联合 TKI/抗 PD-1 抗体作为初始不可切除 HCC 一线治疗的连续患者队列。对系统治疗有反应并符合肝切除术标准的患者行根治性肝切除术。本研究还探讨了临床因素与成功转化性切除和术后复发的关系。
本研究共纳入 101 例患者，其中 24 例（23.8%）患者在系统治疗开始后中位 3.9 个月（四分位距 2.5-5.9 个月）行 R0 切除术。ECOG 体能状态为 0 分、肿瘤数目较少或系统治疗有影像学反应的患者更有可能接受根治性切除术。中位随访 21.5 个月后，肝切除术与总生存的改善独立相关（风险比 [HR]，0.050；95%置信区间 [CI]，0.007-0.365；P = 0.003）。在接受手术的 24 例患者中，12 个月无复发生存率和总生存率分别为 75%和 95.8%。10 例患者对系统治疗达到病理完全缓解（pCR）与术后无复发生存率的改善相关，具有显著趋势（HR，0.345；95%CI，0.067-1.785；P = 0.187）。
选择合适的初始不可切除 HCC 患者可以在接受 TKI/抗 PD-1 抗体联合系统治疗后行肝切除术。在本研究中，转化性切除术与较好的预后相关。
