Wang Jianjun, Luo Hua, Yi Long, Yang Pei, Zeng Xintao
Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China.
Front Surg. 2024 Jan 11;10:1340657. doi: 10.3389/fsurg.2023.1340657. eCollection 2023.
Using TKIs plus anti-PD-1 antibodies combined with TACE in the treatment of patients with initially unresectable multiple HCCs has a high tumour response rate, and using laparoscopic hepatectomy (LH) combined with intraoperative RFA for radical treatment of multiple HCCs after successful downstaging treatment has not been reported.
Consecutive patients with multiple HCCs (≤4 lesions) who were downstaged with TKIs plus anti-PD-1 antibodies combined with TACE were analysed. Imaging examinations were performed monthly, and RECIST v1.1 criteria were used to evaluate treatment effect and resectability.
Forty-five consecutive patients with multiple HCCs who met the inclusion criteria received downstaging treatment with TKIs plus anti-PD-1 antibodies combined with TACE. Nine patients were successfully downstaged and met the R0 resection criteria, and 8 patients underwent surgery. Among the patients, 5 patients had BCLC stage C, and 3 patients had BCLC stage B. There were 2 lesions in 5 patients, 3 lesions in 2 patients, and 4 lesions in 1 patient. The average size of the main HCC was 8.5 cm (range: 5.4-9.1 cm), and the diameter of the remaining HCCs was 1.6 cm (range: 0.8-2.9 cm). The average time from the start of downstaging therapy to surgery was 81 days (range: 60-210 days). All 8 patients underwent LH of the main HCC, and the remaining HCCs were targeted with RFA. The mean operation time was 220 min (range 150-370 min), the average intraoperative blood loss was 260 ml (range 100-750 ml), there was no case conversion to laparotomy, and the average postoperative hospital stay was 9 days (range 7-25 days). The incidence of postoperative complications was 37.5% and there were no deaths. The average follow-up time was 18.2 months (range 6.1-22.4 months), 5 patients survived tumour-free, 2 patients had tumour recurrence, and 1 patient died.
After successful downstaging of multiple HCCs by treatment with TKIs plus anti-PD-1 antibodies and TACE, LH combined with RFA for radical surgery is safe and feasible, and the treatment effect is satisfactory. It is worthy of clinical reference, and its long-term effects require further research for confirmation.
使用酪氨酸激酶抑制剂（TKIs）联合抗程序性死亡蛋白1（PD-1）抗体并结合经动脉化疗栓塞术（TACE）治疗初诊不可切除的多发性肝癌患者，肿瘤缓解率较高，而使用腹腔镜肝切除术（LH）联合术中射频消融术（RFA）对降期成功后的多发性肝癌进行根治性治疗尚未见报道。
对连续使用TKIs联合抗PD-1抗体并结合TACE进行降期治疗的多发性肝癌（≤4个病灶）患者进行分析。每月进行影像学检查，并采用实体瘤疗效评价标准（RECIST）v1.1评估治疗效果和可切除性。
45例符合纳入标准的连续多发性肝癌患者接受了TKIs联合抗PD-1抗体并结合TACE的降期治疗。9例患者成功降期并符合R0切除标准，8例患者接受了手术。患者中，5例为巴塞罗那临床肝癌（BCLC）分期C期，3例为BCLC分期B期。5例患者有2个病灶，2例患者有3个病灶，1例患者有4个病灶。主要肝癌的平均大小为8.5 cm（范围：5.4 - 9.1 cm），其余肝癌的直径为1.6 cm（范围：0.8 - 2.9 cm）。从降期治疗开始到手术的平均时间为81天（范围：60 - 210天）。所有8例患者均接受了主要肝癌的LH，其余肝癌采用RFA靶向治疗。平均手术时间为220 min（范围150 - 370 min），平均术中出血量为260 ml（范围100 - 750 ml），无病例转为开腹手术，平均术后住院时间为9天（范围7 - 25天）。术后并发症发生率为37.5%，无死亡病例。平均随访时间为18.2个月（范围6.1 - 22.4个月），5例患者无瘤生存，2例患者肿瘤复发，1例患者死亡。
通过TKIs联合抗PD-1抗体及TACE治疗使多发性肝癌成功降期后，LH联合RFA进行根治性手术安全可行，治疗效果满意。值得临床参考，其长期效果有待进一步研究证实。
