Shindoh Junichi, Kawamura Yusuke, Akahoshi Keiichi, Matsumura Masaru, Okubo Satoshi, Akuta Norio, Tanabe Minoru, Kokudo Norihiro, Suzuki Yoshiyuki, Hashimoto Masaji
Department of Gastroenterological Surgery, Hepatobiliary-pancreatic Surgery Division, Toranomon Hospital, Tokyo, Japan.
Okinaka Memorial Institute for Medical Disease, Tokyo, Japan.
Liver Cancer. 2024 May 16;13(6):601-609. doi: 10.1159/000539381. eCollection 2024 Dec.
Introduction of new systemic therapies for hepatocellular carcinoma (HCC) has led to the development of new oncological criteria of resectability for the resectability of HCC. This study was aimed at validating the prognosticating ability and clinical utility of the resectability classification based on the novel criteria in real-world clinical practice.
This study was conducted in 1,822 patients who had undergone curative resection for HCC (population 1) and 107 patients with unresectable disease who had received lenvatinib therapy (population 2). Patients were classified into three groups according to the novel oncological criteria for resectability (R, resectable; BR1, borderline resectable 1; and BR2, borderline resectable 2), and the prognosticating ability and clinical utility of this classification based on the novel criteria were examined.
Multivariate analysis confirmed that classification of the patients according to the oncological resectability criteria was significantly correlated with the overall survival (OS) (BR1: hazard ratio [HR], 1.88; 95% CI, 1.38-2.55; BR2: HR, 4.12; 95% CI, 3.01-5.65) and recurrence-free survival (BR1: HR, 1.86; 95% CI, 1.44-2.41; BR2: HR, 3.62; 95% CI, 2.71-4.82) in population 1. In population 2, the resectability classification was correlated with the rates of successful additional intervention (surgery, transarterial chemoembolization, or radiotherapy) (BR1 65.7% vs. BR2 42.3%, = 0.023) and curative-intent conversion surgery (BR1 17.1% vs. BR2 4.2%, = 0.056) after lenvatinib therapy, and was also predictive of the OS (HR, 1.96; 95% CI, 1.13-3.38 for BR2 [vs. BR1]) and time-to-treatment failure (HR, 1.81; 95% CI, 1.04-3.17 for BR2 [vs. BR1]).
The resectability classification based on the novel oncological criteria for resectability showed acceptable prognosticating ability in both surgically and medically treated populations with advanced HCC.
肝细胞癌（HCC）新的全身治疗方法的引入促使了HCC可切除性新的肿瘤学标准的发展。本研究旨在验证基于这些新标准的可切除性分类在真实世界临床实践中的预后预测能力和临床实用性。
本研究纳入了1822例接受HCC根治性切除术的患者（群体1）和107例接受乐伐替尼治疗的不可切除疾病患者（群体2）。根据新的肿瘤学可切除性标准将患者分为三组（R，可切除；BR1，边缘可切除1；BR2，边缘可切除2），并检验基于新标准的该分类的预后预测能力和临床实用性。
多因素分析证实，在群体1中，根据肿瘤学可切除性标准对患者进行分类与总生存期（OS）显著相关（BR1：风险比[HR]，1.88；95%置信区间[CI]，1.38 - 2.55；BR2：HR，4.12；95% CI，3.01 - 5.65）以及无复发生存期（BR1：HR，1.86；95% CI，1.44 - 2.41；BR2：HR，3.62；95% CI，2.71 - 4.82）相关。在群体2中，可切除性分类与乐伐替尼治疗后成功进行额外干预（手术、经动脉化疗栓塞或放疗）的比率（BR1为65.7% vs. BR2为42.3%，P = 0.023）以及根治性意图转换手术（BR1为17.1% vs. BR2为4.2%，P = 0.056）相关，并且还可预测OS（BR2 [对比BR1]的HR，1.96；95% CI，1.13 - 3.38）和治疗失败时间（BR2 [对比BR1]的HR，1.81；95% CI，1.04 - 3.17）。
基于新的肿瘤学可切除性标准的可切除性分类在晚期HCC的手术治疗和药物治疗群体中均显示出可接受的预后预测能力。
