Shin Young Seob, Yun Jae Kwang, Jung Jinhong, Park Jin-Hong, Song Si Yeol, Choi Eun Kyung, Choi Sehoon, Kim Hyeong Ryul, Kim Yong-Hee, Kim Dong Kwan, Lee Geun Dong, Yoon Sang Min
Department of Radiation Oncology.
Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Int J Radiat Oncol Biol Phys. 2025 Feb 1;121(2):432-441. doi: 10.1016/j.ijrobp.2024.09.022. Epub 2024 Sep 17.
Although there is a growing role for local therapy in patients with hepatocellular carcinoma (HCC) and pulmonary oligometastasis, it remains unclear whether metastatectomy or stereotactic body radiation therapy (SBRT) is the more effective treatment for these patients. We aimed to compare the oncologic outcomes of metastasectomy and SBRT for HCC with pulmonary oligometastasis.
We retrospectively analyzed 209 patients with HCC with 322 metastatic lung lesions who underwent either metastasectomy (150 patients with 241 lesions) or SBRT (59 patients with 81 lesions) between January 2008 and December 2018. Propensity score-based inverse probability of treatment weighting was used to minimize potential bias between the 2 groups.
The median follow-up duration was 39.8 months (range, 2.3-166.9 months). The 2-year rate of freedom from local progression was 98.2% in the metastasectomy group and 97.0% in the SBRT group (P = .197). The 2-year rates of overt systemic progression-free survival (PFS) (51.0% vs 46.1%; P = .274), PFS (26.3% vs 9.1%; P = .074), and overall survival (OS, 74.0% vs 57.6%; P = .006) were higher in the metastasectomy group. After the probability of treatment weighting adjustment, the 2-year rates of overt systemic PFS (50.8% vs 52.7%; P = .396), PFS (23.0% vs 24.7%; P = .478), and OS (72.6% vs 83.0%, P = .428) were not significantly different between the 2 groups. In multivariate analysis, viable intrahepatic lesions and the number of prior liver-directed therapies were found to be significant prognostic factors for OS and PFS. The time interval between HCC diagnosis and the development of pulmonary metastases was also significantly associated with OS.
Both metastasectomy and SBRT demonstrated excellent local control and comparable oncologic outcomes in patients with pulmonary oligometastasis from HCC. The treatment modality for these patients could be determined based on the individual patient's condition and intrahepatic disease status.
尽管局部治疗在肝细胞癌（HCC）合并肺寡转移患者中的作用日益增加，但对于这些患者，肝转移瘤切除术或立体定向体部放射治疗（SBRT）哪种治疗更有效仍不清楚。我们旨在比较肝转移瘤切除术和SBRT治疗HCC合并肺寡转移的肿瘤学结局。
我们回顾性分析了2008年1月至2018年12月期间209例患有322个肺转移瘤的HCC患者，这些患者接受了肝转移瘤切除术（150例患者，241个病灶）或SBRT（59例患者，81个病灶）。采用基于倾向评分的治疗权重逆概率法来最小化两组之间的潜在偏倚。
中位随访时间为39.8个月（范围2.3 - 166.9个月）。肝转移瘤切除术组的2年局部无进展率为98.2%，SBRT组为97.0%（P = 0.197）。肝转移瘤切除术组的2年无明显全身进展生存期（PFS）（51.0%对46.1%；P = 0.274）、PFS（26.3%对9.1%；P = 0.074）和总生存期（OS，74.0%对57.6%；P = 0.006）更高。在治疗权重概率调整后，两组的2年无明显全身PFS（50.8%对52.7%；P = 0.396）、PFS（23.0%对24.7%；P = 0.478）和OS（72.6%对83.0%，P = 0.428）无显著差异。在多变量分析中，肝内有活性病灶和既往肝导向治疗的次数被发现是OS和PFS的重要预后因素。HCC诊断与肺转移发生之间的时间间隔也与OS显著相关。
肝转移瘤切除术和SBRT在HCC肺寡转移患者中均显示出良好的局部控制和相当的肿瘤学结局。这些患者的治疗方式可根据个体患者情况和肝内疾病状态来确定。
