Duan Wen-Bin, Wang Xiao-Hui, Zhang Guo-Can, He Zhuo, Li Shao-Qiang, Zhou Jie
Division of Hepatobiliopancreatic Surgery, Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, People's Republic of China.
Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, 410005, People's Republic of China.
Immunotargets Ther. 2024 May 16;13:247-258. doi: 10.2147/ITT.S452339. eCollection 2024.
Lenvatinib or Sorafenib combined with programmed cell death protein-1 (PD-1) inhibitor as recommend treatment of advanced hepatocellular carcinoma (HCC) with extrahepatic metastasis (EHM). We aimed to compared the prognosis of Lenvatinib plus PD-1 inhibitor (Len+PD-1) versus Sorafenib plus PD-1 (Sora+PD-1) as an initial therapy for HCC with EHM.
Incorporating a sum of 229 HCC patients with EHM were encompassed within this study, with 127 in the Sora+PD-1 group and 102 in the Len+PD-1 group. Through propensity score matching (PSM), we compared overall survival (OS), progression-free survival (PFS), and patient safety between these two groups.
The median OS were 13.0 months and 14.2 months in the Sora+PD-1 group and Len+PD-1 group. The 6-, 12-, and 24-month OS rates were 92.9%, 58.9% and 5.6% in Sora+PD-1 group and 93.1%, 61.8% and 22.6% in Len+PD-1 group, respectively. The Len+PD-1 group had obviously better OS than the Sora+PD-1 group ( = 0.002). The 3-, 6-, and 12-month PFS rates were 76.4%, 27.6% and 1.6% in Sora+PD-1 group and 86.2%, 50.5% and 12.2% in Len+PD-1 group, respectively. Compared with Sora+PD-1 group, the Len+PD-1 group had obviously better PFS ( < 0.001). Analysis within subgroups showed that OS was significant in patients receiving TACE in Len+PD-1 group than Sora+PD-1 group ( = 0.003).
Len+PD-1 group had longer OS and PFS than Sora+PD-1 group for patient with EHM. In addition, OS in patients received TACE was improved with Len+PD-1 treatment. For patients without TACE, there was no significance between Sora+PD-1 and Len+PD-1 groups.
乐伐替尼或索拉非尼联合程序性细胞死亡蛋白1（PD-1）抑制剂被推荐用于治疗伴有肝外转移（EHM）的晚期肝细胞癌（HCC）。我们旨在比较乐伐替尼联合PD-1抑制剂（Len+PD-1）与索拉非尼联合PD-1（Sora+PD-1）作为伴有EHM的HCC初始治疗方案的预后。
本研究纳入了229例伴有EHM的HCC患者，索拉非尼联合PD-1组127例，乐伐替尼联合PD-1组102例。通过倾向评分匹配（PSM），我们比较了两组的总生存期（OS）、无进展生存期（PFS）和患者安全性。
索拉非尼联合PD-1组和乐伐替尼联合PD-1组的中位OS分别为13.0个月和14.2个月。索拉非尼联合PD-1组6个月、12个月和24个月的OS率分别为92.9%、58.9%和5.6%，乐伐替尼联合PD-1组分别为93.1%、61.8%和22.6%。乐伐替尼联合PD-1组的OS明显优于索拉非尼联合PD-1组（P = 0.002）。索拉非尼联合PD-1组3个月、6个月和12个月的PFS率分别为76.4%、27.6%和1.6%，乐伐替尼联合PD-1组分别为86.2%、50.5%和12.2%。与索拉非尼联合PD-1组相比，乐伐替尼联合PD-1组的PFS明显更好（P < 0.001）。亚组分析显示，乐伐替尼联合PD-1组接受经动脉化疗栓塞术（TACE）的患者的OS比索拉非尼联合PD-1组更显著（P = 0.003）。
对于伴有EHM的患者，乐伐替尼联合PD-1组的OS和PFS比索拉非尼联合PD-1组长。此外，乐伐替尼联合PD-1治疗可改善接受TACE患者的OS。对于未接受TACE的患者，索拉非尼联合PD-1组和乐伐替尼联合PD-1组之间无显著差异。
