Sun Juxian, Liu Chang, Tao Xiandong, Yang Yu, Jin Hai, Cheng Shuqun, Shi Huazheng, Yan Maolin, Shi Jie
Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.
Department of Thoracic Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.
Liver Res. 2025 Jan 30;9(1):29-35. doi: 10.1016/j.livres.2025.01.006. eCollection 2025 Mar.
Advanced hepatocellular carcinoma (HCC) with pulmonary metastasis (PM) has a poor prognosis, and optimal treatment strategies remain controversial. This study aimed to compare the long-term outcomes of patients with advanced HCC with PM who were treated with resection of pulmonary metastases versus those treated with targeted therapies combined with immunotherapy.
A retrospective analysis was conducted on the medical records of HCC patients with PM who underwent either pulmonary metastasectomy or immunotherapy combined with targeted therapies at the Eastern Hepatobiliary Surgery Hospital, Changhai Hospital of Shanghai, Fujian Provincial Hospital, and West China Hospital of Sichuan University from September 2013 to October 2022. One-to-one propensity score matching (PSM) was employed to control the influence of potential confounders, and the survival outcomes were compared.
A total of 119 HCC patients with PM were included in this study. The overall survival (OS) of patients who underwent pulmonary metastasectomy was significantly longer than that of patients who received immunotherapy targeted combinations (OS: 1-year, 80.0% 59.3%; 2-year, 31.7% 20.3%; 3-year, 20.0% 0; < 0.001). After PSM, the long-term prognosis of the pulmonary metastasectomy group remained significantly better than that of the immunotherapy combination group (OS: 1-year, 87.0% 69.6%; 2-year, 34.8% 30.4%; 3-year, 21.7% 0; = 0.005). Multivariate analysis revealed that treatment allocation (hazard ratio (HR) = 2.177, 95% confidence interval (CI) = 1.068-4.439) and hepatic tumor T stage (HR = 2.342, 95% CI = 1.209-4.538) were independent risk factors for OS.
Pulmonary metastasectomy was associated with improved survival compared to immunotherapy combined with targeted therapies and may represent an optimal treatment option for highly selected HCC patients with resectable PM.
伴有肺转移（PM）的晚期肝细胞癌（HCC）预后较差，最佳治疗策略仍存在争议。本研究旨在比较接受肺转移灶切除术的晚期HCC合并PM患者与接受靶向治疗联合免疫治疗的患者的长期预后。
对2013年9月至2022年10月在上海东方肝胆外科医院、上海长海医院、福建省立医院和四川大学华西医院接受肺转移灶切除术或免疫治疗联合靶向治疗的HCC合并PM患者的病历进行回顾性分析。采用一对一倾向评分匹配（PSM）来控制潜在混杂因素的影响，并比较生存结局。
本研究共纳入119例HCC合并PM患者。接受肺转移灶切除术的患者的总生存期（OS）显著长于接受免疫治疗靶向联合治疗的患者（OS：1年，80.0%对59.3%；2年，31.7%对20.3%；3年，20.0%对0；<0.001）。PSM后，肺转移灶切除术组的长期预后仍显著优于免疫治疗联合组（OS：1年，87.0%对69.6%；2年，34.8%对30.4%；3年，21.7%对0；=0.005）。多因素分析显示，治疗分配（风险比（HR）=2.177，95%置信区间（CI）=1.068 - 4.439）和肝肿瘤T分期（HR = 2.342，95% CI = 1.209 - 4.538）是OS的独立危险因素。
与免疫治疗联合靶向治疗相比，肺转移灶切除术可改善生存，可能是高度选择的可切除PM的HCC患者的最佳治疗选择。
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