Zhou Jiangmin, Xiong Huifang, Zhang Zhiwei, Chen Dong, Wang Wei, Zhou Cheng, Wu Biao
Department of Hepatobiliary Surgery, Wuhan No.1 Hospital (Wuhan Hospital of Traditional Chinese and Western Medicine), Wuhan, China.
Department of Digestive Internal Medicine, Wuhan Dongxihu District People Hospital, Wuhan, China.
Front Surg. 2024 Aug 7;11:1387246. doi: 10.3389/fsurg.2024.1387246. eCollection 2024.
Portal vein tumor thrombus (PVTT) is a major risk factor of recurrence of hepatocellular carcinoma (HCC) after hepatectomy. Whether postoperative adjuvant immunotherapy and molecular targeted therapy (I-O and MTT) is effective in reducing the risk of recurrence of HCC with minimal portal invasion after hepatectomy and improving prognosis is unknown.
We collected the data of HCC with Vp1 or Vp2 PVTT patients who underwent hepatectomy at our center between January 2019 and June 2022 from the hospital database. We utilized propensity score matching (PSM) to establish a 1:1 match between the postoperative group treated with I-O and MTT and the postoperative group without I-O and MTT. To compare the recurrence-free survival (RFS) and overall survival (OS) between the two groups, we employed the Kaplan-Meier method. Additionally, we conducted Cox regression analysis to identify the prognostic factors that influence patient prognosis. To account for different high-risk factors, subgroup analyses were carried out.
Among the 189 patients included in the study, 42 patients received postoperative adjuvant I-O and MTT. After PSM, the 1, 2-years RFS were 59.2%, 21.3% respectively in the I-O and MTT group and 40.8%, 9.6% respectively in the non-I-O and MTT group. The median RFS was 13.2 months for the I-O and MTT group better than 7.0 months for the non-I-O and MTT group ( = 0.028). 1, 2-years OS were 89.8%, 65.8% respectively in the I-O and MTT group and 42.4%, 27.7% respectively in the non-I-O and MTT group. The median OS was 23.5 months for the I-O and MTT group better than 17.2 months for the non-I-O and MTT group ( = 0.027). Multivariate analysis showed that postoperative adjuvant I-O and MTT was a prognostic protective factor associated with OS and RFS. The most frequent AE observed in this study was pruritus, and rare AEs included decreased platelet, hypothyroidism, proteinuria, myocarditis and hypoadrenocorticism. The incidence of GRADE ≥3 AE with no deaths recorded.
The study suggested that postoperative adjuvant I-O and MTT strategy was beneficial to improve the prognosis of HCC patients with PVTT patients, while the therapy was safe and reliable.
门静脉癌栓（PVTT）是肝细胞癌（HCC）肝切除术后复发的主要危险因素。肝切除术后辅助免疫治疗和分子靶向治疗（I-O和MTT）是否能有效降低门静脉侵犯程度较轻的HCC患者的复发风险并改善预后尚不清楚。
我们从医院数据库中收集了2019年1月至2022年6月在本中心接受肝切除术的Vp1或Vp2 PVTT的HCC患者的数据。我们采用倾向评分匹配（PSM）方法，在接受I-O和MTT治疗的术后组与未接受I-O和MTT治疗的术后组之间建立1:1匹配。为比较两组之间的无复发生存期（RFS）和总生存期（OS），我们采用了Kaplan-Meier方法。此外，我们进行了Cox回归分析，以确定影响患者预后的预后因素。为考虑不同的高危因素，我们进行了亚组分析。
在纳入研究的189例患者中，42例患者接受了术后辅助I-O和MTT治疗。PSM后，I-O和MTT组的1年、2年RFS分别为59.2%、21.3%，非I-O和MTT组分别为40.8%、9.6%。I-O和MTT组的中位RFS为13.2个月，优于非I-O和MTT组的7.0个月（P = 0.028）。I-O和MTT组的1年、2年OS分别为89.8%、65.8%，非I-O和MTT组分别为42.4%、27.7%。I-O和MTT组的中位OS为23.5个月，优于非I-O和MTT组的17.2个月（P = 0.027）。多因素分析显示，术后辅助I-O和MTT是与OS和RFS相关的预后保护因素。本研究中观察到的最常见不良事件是瘙痒，罕见的不良事件包括血小板减少、甲状腺功能减退、蛋白尿、心肌炎和肾上腺皮质功能减退。≥3级不良事件的发生率无死亡记录。
该研究表明，术后辅助I-O和MTT策略有利于改善PVTT的HCC患者的预后，同时该治疗安全可靠。
