Hou Guimin, Zhang Feng, Feng Xielin, Chen Yan, Zhang Jinliang, Wang Haiqing
Department of Hepatopancreatobiliary Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, People's Republic of China.
Department of Pharmacy, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, People's Republic of China.
J Hepatocell Carcinoma. 2024 Aug 20;11:1581-1595. doi: 10.2147/JHC.S479810. eCollection 2024.
Hepatectomy could provide better survival benefit for hepatocellular carcinoma (HCC) with type I/II portal vein tumor thrombosis (PVTT). However, the postoperative recurrence remains high. We discussed whether neoadjuvant therapy could reduce HCC recurrence for these patients.
One hundred and thirty-eight resectable HCC with type I-II PVTT were retrospectively included. The neoadjuvant therapy regimens included tyrosine kinase inhibitor (TKI), programmed death 1(PD-1) antibodies and transarterial chemoembolization (TACE). Short-term and long-term outcomes were compared. Propensity score matching (PSM) was performed to minimize the influence of potential confounders.
Thirty-three patients underwent neoadjuvant therapy and 105 patients underwent surgery alone. In the neoadjuvant group, 7 (21.2%) patients achieved stable disease, 13 (39.4%) achieved partial response and 13 (39.4%) achieved complete response based on the modified Response Evaluation Criteria in Solid Tumors criterion. By PSM, the neoadjuvant therapy resulted in less microvascular invasion (24.1% vs 50.0%, P=0.021), satellite nodule (6.9% vs 24.1%, P=0.036) and less patients with alpha-fetoprotein>20(ng/mL) (37.9% vs 69.0%, P=0.006). The neoadjuvant therapy reduced tumor recurrence and prolonged survival. Multivariate analysis found that neoadjuvant therapy was an independent protective factor for overall survival and recurrence free survival.
Neoadjuvant treatment presents a promising treatment option for HCC patients with type I/II PVTT.
肝切除术可为伴有I/II型门静脉肿瘤血栓形成（PVTT）的肝细胞癌（HCC）患者带来更好的生存获益。然而，术后复发率仍然很高。我们探讨了新辅助治疗是否可以降低这些患者的HCC复发率。
回顾性纳入138例可切除的伴有I-II型PVTT的HCC患者。新辅助治疗方案包括酪氨酸激酶抑制剂（TKI）、程序性死亡1（PD-1）抗体和经动脉化疗栓塞术（TACE）。比较短期和长期结局。进行倾向评分匹配（PSM）以尽量减少潜在混杂因素的影响。
33例患者接受了新辅助治疗，105例患者仅接受了手术。在新辅助治疗组中，根据实体瘤改良反应评估标准，7例（21.2%）患者病情稳定，13例（39.4%）患者部分缓解，13例（39.4%）患者完全缓解。通过PSM，新辅助治疗导致微血管侵犯较少（24.1%对50.0%，P=0.021）、卫星结节较少（6.9%对24.1%，P=0.036）且甲胎蛋白>20（ng/mL）的患者较少（37.9%对69.0%，P=0.006）。新辅助治疗降低了肿瘤复发率并延长了生存期。多因素分析发现新辅助治疗是总生存期和无复发生存期的独立保护因素。
新辅助治疗为伴有I/II型PVTT的HCC患者提供了一种有前景的治疗选择。
