Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Cancer Res Commun. 2024 Aug 1;4(8):2123-2132. doi: 10.1158/2767-9764.CRC-24-0151.
UNLABELLED: Surgical resection for localized hepatocellular carcinoma (HCC) is typically reserved for a minority of patients with favorable tumor features and anatomy. Neoadjuvant immunotherapy can expand the number of patients who are candidates for surgical resection and potentially reduce the chance for recurrence, but its role in HCC not defined. We retrospectively examined the outcomes of patients who underwent surgical resection for HCC at the Johns Hopkins Hospital and compared the clinical outcomes of patients who received neoadjuvant immunotherapy with those who underwent upfront resection. The clinical cohort included a total of 92 patients, 36 of whom received neoadjuvant immune checkpoint inhibitor (ICI)-based treatment. A majority of patients (61.1%) who received neoadjuvant ICI-based therapy were outside of standard resectability criteria and were more likely to have features known to confer risk of disease recurrence, including α-fetoprotein ≥ 400 ng/mL (P = 0.02), tumor diameter ≥ 5 cm (P = 0.001), portal vein invasion (P < 0.001), and multifocality (P < 0.001). Patients who received neoadjuvant immunotherapy had similar rates of margin-negative resection (P = 0.47) and recurrence-free survival (RFS) as those who underwent upfront surgical resection (median RFS 44.8 months compared with 49.3 months, respectively, log-rank P = 0.66). There was a nonsignificant trend toward superior RFS in the subset of patients with a pathologic response (tumor necrosis ≥ 70%) with neoadjuvant immunotherapy. Neoadjuvant ICI-based therapy may allow high-risk patients, including those who are outside traditional resectability criteria, to achieve comparable clinical outcomes with those who undergo upfront resection. SIGNIFICANCE: Surgical resection for localized HCC is typically only reserved for those with solitary tumors without vascular invasion. In this retrospective analysis, we show that neoadjuvant immunotherapy may allow high-risk patients, including those who are outside of standard resection criteria, to undergo successful margin-negative resection and achieve comparable long-term clinical outcomes compared with upfront resection. These findings highlight need for prospective studies on neoadjuvant immunotherapy in HCC.
未加标签：手术切除局部肝细胞癌 (HCC) 通常仅保留给具有有利肿瘤特征和解剖结构的少数患者。新辅助免疫治疗可以扩大接受手术切除的患者数量，并有可能降低复发的机会，但它在 HCC 中的作用尚未确定。我们回顾性检查了在约翰霍普金斯医院接受 HCC 手术切除的患者的结果，并比较了接受新辅助免疫治疗的患者与直接接受手术切除的患者的临床结果。临床队列共包括 92 名患者，其中 36 名接受了新辅助免疫检查点抑制剂 (ICI) 治疗。大多数接受新辅助 ICI 治疗的患者（61.1%）超出了标准可切除标准，并且更有可能具有已知会增加疾病复发风险的特征，包括 α-胎蛋白≥400ng/ml（P=0.02）、肿瘤直径≥5cm（P=0.001）、门静脉侵犯（P<0.001）和多灶性（P<0.001）。接受新辅助免疫治疗的患者与直接接受手术切除的患者具有相似的阴性切缘率（P=0.47）和无复发生存率（RFS）（中位 RFS 分别为 44.8 个月和 49.3 个月，对数秩 P=0.66）。在接受新辅助免疫治疗的患者亚组中，具有病理反应（肿瘤坏死≥70%）的患者具有更好的 RFS 趋势，但无统计学意义。新辅助 ICI 治疗可能使高危患者，包括那些超出传统可切除标准的患者，获得与直接切除相当的临床结果。 意义：手术切除局部 HCC 通常仅保留给那些具有无血管侵犯的孤立肿瘤的患者。在这项回顾性分析中，我们表明新辅助免疫治疗可能使高危患者，包括那些超出标准切除标准的患者，能够成功进行阴性切缘切除，并获得与直接切除相当的长期临床结果。这些发现强调了需要对 HCC 的新辅助免疫治疗进行前瞻性研究。
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