乐伐替尼与索拉非尼治疗肝移植术后肝细胞癌复发的疗效对比分析

Comparative Outcome Analysis of Lenvatinib Versus Sorafenib for Recurrence of Hepatocellular Carcinoma After Liver Transplantation.

作者信息

Magyar Christian T J, Perera Sheron, Rajendran Luckshi, Li Zhihao, Almugbel Fahad A, Feng Sophie, Choi Woo Jin, Aceituno Laia, Vogel Arndt, Grant Robert C, Selzner Nazia, Jaeckel Elmar, Falla-Rad Nazanin, Knox Jennifer J, Chen Eric X, Sapisochin Gonzalo, O'Kane Grainne M

机构信息

University Health Network, HPB Surgical Oncology, Toronto, ON, Canada.

Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.

出版信息

Transplantation. 2025 Apr 1;109(4):681-690. doi: 10.1097/TP.0000000000005240. Epub 2024 Nov 6.

DOI:10.1097/TP.0000000000005240

PMID:39531339

Abstract

BACKGROUND

Hepatocellular carcinoma (HCC) recurs after liver transplantation (LT) in ~17% of patients. We aimed to retrospectively compare the outcomes of patients treated with different tyrosine kinase inhibitors (TKIs) for recurrent HCC post-LT.

METHODS

Patients with recurrent HCC post-LT between 2006 and 2019 were included. The impact of sorafenib and lenvatinib treatment for recurrent disease was assessed using survival analysis with an a priori multivariable Cox regression (alpha-fetoprotein [AFP] at recurrence, recurrence lesion diameter, single-site versus multisite metastases).

RESULTS

Seven hundred fifty-four patients underwent LT for HCC, of whom 120 (15.9%) developed recurrence. Of these patients, 56 received TKIs: sorafenib (n = 42) or lenvatinib (n = 14). The median age at LT was 60.8 y (interquartile range, 54.0-66.2); 52 (93%) were men and 26 (46%) were within Milan criteria at listing. Baseline characteristics at recurrence were comparable between the 2 groups, including largest tumor diameter ( P = 0.15), receipt of local therapies before TKI ( P = 0.33), and single-site recurrence ( P = 0.75), and time from interventional treatment to start of TKI ( P = 0.44). The AFP at recurrence was higher in the sorafenib group (95.0 versus 3.0 µg/L, P < 0.001). The median overall survival (OS) after initiation of TKI treatment was longer in the lenvatinib group (15.0 mo [95% confidence interval [CI], 11.5-31.5] versus 7.8 mo [95% CI, 4.0-15.4]; P = 0.02) with a 2.3-fold a priori adjusted effect on OS (adjusted hazard ratio 2.32 [95% CI, 1.03-5.20], P = 0.04).

CONCLUSIONS

Our findings suggest lenvatinib is a valuable treatment option for patients with HCC recurrence after LT.

摘要

背景

肝细胞癌（HCC）患者在肝移植（LT）后约17%会复发。我们旨在回顾性比较不同酪氨酸激酶抑制剂（TKIs）治疗LT后复发性HCC患者的疗效。

方法

纳入2006年至2019年间LT后复发性HCC患者。采用生存分析和先验多变量Cox回归（复发时甲胎蛋白[AFP]、复发灶直径、单部位与多部位转移）评估索拉非尼和仑伐替尼治疗复发性疾病的影响。

结果

754例患者因HCC接受LT，其中120例（15.9%）出现复发。这些患者中，56例接受了TKIs治疗：索拉非尼（n = 42）或仑伐替尼（n = 14）。LT时的中位年龄为60.8岁（四分位间距，54.0 - 66.2）；52例（93%）为男性，26例（46%）在列入名单时符合米兰标准。两组复发时的基线特征具有可比性，包括最大肿瘤直径（P = 0.15）、在接受TKI治疗前接受局部治疗的情况（P = 0.33）、单部位复发（P = 0.75）以及从介入治疗到开始TKI治疗的时间（P = 0.44）。索拉非尼组复发时的AFP更高（95.0对3.0 μg/L，P < 0.001）。仑伐替尼组TKI治疗开始后的中位总生存期（OS）更长（15.0个月[95%置信区间[CI]，11.5 - 31.5]对7.8个月[95% CI，4.0 - 15.4]；P = 0.02），对OS有2.3倍的先验调整效应（调整后风险比2.32 [95% CI，1.03 - 5.20]，P = 0.04）。