Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, People's Republic of China.
Department of Hepatobiliary and Pancreatic Surgery, Fujian Provincial Hospital of Fujian Medical University, Fuzhou, People's Republic of China.
Oncologist. 2024 Aug 5;29(8):e1041-e1050. doi: 10.1093/oncolo/oyae032.
This study aimed to compare the survival outcomes of patients with initially unresectable hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT) who underwent or did not undergo salvage surgery followed by a triple combination conversion treatment consisted of locoregional treatment (LRT), tyrosine kinase inhibitors (TKIs), and anti-PD-1 antibodies.
The data from 93 consecutive patients with initially unresectable HCC and PVTT across 4 medical centers were retrospectively reviewed. They were converted successfully by the triple combination treatment and underwent or did not undergo salvage resection. The baseline characteristics, conversion schemes, conversion treatment-related adverse events (CTRAEs), overall survival (OS), and progression-free survival (PFS) of the salvage surgery and non-surgery groups were compared. Multivariate Cox regression analysis was performed to identify independent risk factors for OS and PFS. Additionally, subgroup survival analysis was conducted by stratification of degree of tumor response and type of PVTT.
Of the 93 patients, 44 underwent salvage surgery, and 49 did not undergo salvage surgery. The OS and PFS of the salvage surgery and non-surgery groups were not significantly different (P = .370 and .334, respectively). The incidence and severity of CTRAEs of the 2 groups were also comparable. Subgroup analyses revealed that for patients with complete response (CR) or types III-IV PVTT, there was a trend toward better survival in patients who did not undergo salvage surgery. Multivariate analysis showed that baseline α-fetoprotein and best tumor response per mRECIST criteria were independent prognostic factors for OS and PFS.
For patients with initially unresectable HCC and PVTT who were successfully converted by the triple combination therapy, salvage liver resection may not be necessary, especially for the patients with CR or types III-IV PVTT.
本研究旨在比较接受或未接受挽救性手术联合三联转化治疗（局部区域治疗、酪氨酸激酶抑制剂和抗 PD-1 抗体）的初治不可切除肝细胞癌（HCC）伴门静脉癌栓（PVTT）患者的生存结局。
回顾性分析了 4 家医疗中心的 93 例连续初治不可切除 HCC 伴 PVTT 患者的数据。这些患者通过三联转化治疗成功转化，接受或未接受挽救性肝切除术。比较了挽救性手术和非手术组的基线特征、转化方案、转化治疗相关不良事件（CTRAEs）、总生存期（OS）和无进展生存期（PFS）。采用多因素 Cox 回归分析确定 OS 和 PFS 的独立危险因素。此外，还通过肿瘤反应程度和 PVTT 类型进行了亚组生存分析。
93 例患者中，44 例行挽救性手术，49 例未行挽救性手术。挽救性手术组和非手术组的 OS 和 PFS 无显著差异（P 值分别为.370 和.334）。两组 CTRAEs 的发生率和严重程度也相当。亚组分析显示，对于完全缓解（CR）或 III-IV 型 PVTT 的患者，未行挽救性手术的患者生存趋势较好。多因素分析显示，基线甲胎蛋白和最佳肿瘤缓解（mRECIST 标准）是 OS 和 PFS 的独立预后因素。
对于通过三联转化治疗成功转化的初治不可切除 HCC 伴 PVTT 患者，挽救性肝切除术可能不是必需的，特别是对于 CR 或 III-IV 型 PVTT 的患者。
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