Leng Boyu, Wang Haohua, Ge Yunfan, Sun Xiaoli, Dong Pingping, Dong Xinzhe, Duan Xuezhang, Wang Quan, Xia Yaoxiong, Ding Lijuan, Dai Honghai, Liu Tianxing, Shi Fang, Zhang Xiang, Yue Jinbo
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China; Cheeloo College of Medicine, Shandong University Cancer Center, Jinan, Shandong, China.
Int J Radiat Oncol Biol Phys. 2025 Jun 1;122(2):325-338. doi: 10.1016/j.ijrobp.2024.12.039. Epub 2025 Jan 15.
Optimal treatment strategies for patients with hepatocellular carcinoma with oligoprogression after first-line systemic therapy (FLST) remain undefined. We aimed to determine whether maintaining (ie, continuing) FLST plus radiation therapy (RT) for oligoprogressive lesions (m-FLST + RT) would result in progression-free survival (PFS) equal to or greater than that of second-line systemic therapy (s-SLST), either alone or with RT (s-SLST + RT).
From October 2018 to February 2024, 154 patients from 7 medical centers who developed oligoprogression after FLST were enrolled and assigned to 1 of 3 groups based on post-oligoprogression treatment strategy: m-FLST + RT, s-SLST + RT, or s-SLST-only. The primary outcome was PFS, and early patterns of recurrence were noted.
At a median follow-up time of 8.4 months, the median PFS time was longer in the m-FLST + RT group (8.6 months) compared with the s-SLS-only group (3.1 months) (hazard ratio, 3.163; 95% CI, 2.133-4.690; P < .001) and the s-SLST + RT group (5.8 months) (hazard ratio, 2.183; 95% CI, 1.110-4.293; P = .006). Multivariate Cox analysis demonstrated that albumin-bilirubin (ALBI) grade and postoligoprogression treatment strategy were independent prognostic factors for PFS. Stratified analysis by ALBI grade showed that m-FLST + RT resulted in significantly longer median PFS in patients with both ALBI-1 and ALBI-2 compared with s-SLST-only (P < .001). Regarding subsequent patterns of relapse, the m-FLST + RT group had a lower rate of re-enlargement of recently oligoprogressive lesions (27.6%) than the s-SLST + RT (31.8%) and s-SLST-only (50.0%) groups. It also had the lowest rate of re-enlargement of previously identified metastases that did not progress during FLST (13.8%) compared with s-SLRT + RT (27.3%) and s-SLST-only (24.4%).
Our study suggests a potential clinical benefit of m-FLST + RT without the need for s-SLST and provides insights to optimize treatment strategies for oligoprogressive hepatocellular carcinoma.
一线全身治疗（FLST）后出现寡进展的肝细胞癌患者的最佳治疗策略仍不明确。我们旨在确定对寡进展性病变维持（即继续）FLST加放射治疗（RT）（m-FLST + RT）是否会导致无进展生存期（PFS）等于或大于二线全身治疗（s-SLST）单独使用或联合RT（s-SLST + RT）的PFS。
2018年10月至2024年2月，来自7个医疗中心的154例在FLST后出现寡进展的患者入组，并根据寡进展后的治疗策略分为3组之一：m-FLST + RT、s-SLST + RT或单纯s-SLST。主要结局为PFS，并记录早期复发模式。
在中位随访时间8.4个月时，m-FLST + RT组的中位PFS时间（8.6个月）长于单纯s-SLS组（3.1个月）（风险比，3.163；95%CI，2.133 - 4.690；P <.001）和s-SLST + RT组（5.8个月）（风险比，2.183；95%CI，1.110 - 4.293；P =.006）。多因素Cox分析表明，白蛋白-胆红素（ALBI）分级和寡进展后的治疗策略是PFS的独立预后因素。按ALBI分级进行分层分析显示，与单纯s-SLST相比，m-FLST + RT使ALBI-1和ALBI-2患者的中位PFS显著更长（P <.001）。关于后续复发模式，m-FLST + RT组近期寡进展性病变再次增大的发生率（27.6%）低于s-SLST + RT组（31.8%）和单纯s-SLST组（50.0%）。与s-SLRT + RT组（27.3%）和单纯s-SLST组（24.4%）相比，其在FLST期间未进展的先前已确定转移灶再次增大的发生率也最低（13.8%）。
我们的研究表明m-FLST + RT可能具有临床益处，无需s-SLST，并为优化寡进展性肝细胞癌的治疗策略提供了见解。
