Wu Jia-Yi, Zhang Zhi-Bo, Zhou Jian-Yin, Ke Jing-Peng, Bai Yan-Nan, Chen Yu-Feng, Wu Jun-Yi, Zhou Song-Qiang, Wang Shuang-Jia, Zeng Zhen-Xin, Li Yi-Nan, Qiu Fu-Nan, Li Bin, Yan Mao-Lin
Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.
Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China.
Liver Cancer. 2022 Nov 30;12(3):229-237. doi: 10.1159/000528356. eCollection 2023 Aug.
The actual rate of conversion surgery and its prognostic advantages remain unclear. This study aimed to assess the outcomes of salvage surgery after conversion therapy with triple therapy (transcatheter arterial chemoembolization [TACE] combined with lenvatinib plus anti-PD-1 antibodies) in patients with initially unresectable hepatocellular carcinoma (uHCC).
Patients with initially uHCC who received at least one cycle of first-line triple therapy and salvage surgery at five major cancer centers in China were included. The primary endpoints were overall survival (OS) and recurrence-free survival (RFS) rates after salvage surgery. The secondary endpoints were perioperative complications, 90-day mortality, and pathological tumor response.
Between June 2018 and December 2021, 70 patients diagnosed with uHCC who underwent triple therapy and salvage surgery were analyzed: 39 with Barcelona Clinic Liver Cancer (BCLC) stage C, 22 with BCLC stage B, and 9 with BCLC stage A disease. The median interval between the start of triple therapy and salvage surgery was 4.3 months (range, 1.7-14.2 months). Pathological complete response and major pathological response were observed in 29 (41.4%) and 59 (84.3%) patients, respectively. There were 2 cases of perioperative mortality (4.3%) and 5 cases of severe perioperative complications (7.1%). With a median follow-up of 12.9 months after surgery (range, 0.3-36.8 months), the median OS and RFS were not reached. The 1- and 2-year OS rates were 97.1% and 94.4%, respectively, and the corresponding RFS rates were 68.9% and 54.4%, respectively.
First-line combination of TACE, lenvatinib, and anti-PD-1 antibodies provides a better chance of conversion therapy in patients with initially uHCC. Furthermore, salvage surgery after conversion therapy is effective and safe and has the potential to provide excellent long-term survival benefits.
转化手术的实际发生率及其预后优势尚不清楚。本研究旨在评估初始不可切除肝细胞癌（uHCC）患者接受三联疗法（经动脉化疗栓塞术[TACE]联合乐伐替尼加抗PD-1抗体）转化治疗后挽救性手术的疗效。
纳入在中国五个主要癌症中心接受至少一个周期一线三联疗法及挽救性手术的初始uHCC患者。主要终点为挽救性手术后的总生存期（OS）和无复发生存期（RFS）率。次要终点为围手术期并发症、90天死亡率和病理肿瘤反应。
2018年6月至2021年12月期间，对70例诊断为uHCC并接受三联疗法及挽救性手术的患者进行了分析：39例为巴塞罗那临床肝癌（BCLC）C期，22例为BCLC B期，9例为BCLC A期疾病。三联疗法开始至挽救性手术的中位间隔时间为4.3个月（范围1.7 - 14.2个月）。分别有29例（41.4%）和59例（84.3%）患者观察到病理完全缓解和主要病理缓解。围手术期死亡2例（4.3%），严重围手术期并发症5例（7.1%）。术后中位随访12.9个月（范围0.3 - 36.8个月），OS和RFS的中位值均未达到。1年和2年OS率分别为97.1%和94.4%，相应的RFS率分别为68.9%和54.4%。
TACE、乐伐替尼和抗PD-1抗体的一线联合治疗为初始uHCC患者提供了更好的转化治疗机会。此外，转化治疗后的挽救性手术有效且安全，有可能带来出色的长期生存获益。
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