不可切除肝细胞癌转化治疗完全或部分缓解后肝切除的生存获益（GUIDANCE003）：一项多中心研究

Survival Benefit of Hepatectomy after Complete or Partial Response to Conversion Therapy in Unresectable Hepatocellular Carcinoma (GUIDANCE003): A Multicenter Study.

作者信息

Yang Da-Long, Peng Ning, Nong Jun-Liang, Chen Kang, Su Ze, Yu Ya-Qun, Ye Lin, Zeng Fan-Jian, Liu Shao-Ping, Yan Yi-He, Wang Xue-Yao, Yao Hong-Bing, Yang Fu-Quan, Li Wen-Feng, Qin Chuang, Wu Ming-Song, Yang Yong-Yu, Dong Xiao-Feng, Li Mian-Jing, Liu Jie, Liang Yong-Rong, Wu Pei-Sheng, Zhong Teng-Meng, Lai Yong-Cheng, Chen Yao-Zhi, Pang Qing-Qing, Wang Guo-Dong, Li Fu-Xin, Mao Xian-Shuang, Chen Shu-Chang, Ou Jun-Jie, Huo Rong-Rui, Liang Xiu-Mei, Xiang Bang-De, Ma Liang, Zhong Jian-Hong

机构信息

Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China.

Department of Hepatobiliary Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China.

出版信息

Liver Cancer. 2025 Apr 23:1-17. doi: 10.1159/000546052.

DOI:10.1159/000546052

PMID:40496213

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12148338/

Abstract

INTRODUCTION

Uncertainty exists regarding whether hepatectomy enhances the prognosis for initially unresectable hepatocellular carcinoma (HCC) that becomes resectable subsequent to conversion therapy. This study conducted a comparative analysis of survival rates between patients who underwent hepatectomy and those who did not, following complete or partial response to conversion therapy.

METHODS

This retrospective study examined 300 patients with HCC who underwent hepatectomy following conversion therapy, along with 265 nonsurgical control subjects (215 receiving locoregional/systemic therapy and 50 under active surveillance) across 20 Chinese medical centers from 2019 to 2023. The primary outcomes assessed included overall survival (OS), event-free survival (EFS), recurrence-free survival, and the rate of complete pathological response.

RESULTS

Hepatectomy was associated with significantly better OS than locoregional or systemic therapy or active surveillance (the 3-year OS rates were 79.9% and 58.5%, respectively, < 0.001) but comparable EFS (median: 40.6 vs 33.4 months, = 0.403). These results were confirmed after analyzing subgroups matched to each other based on propensity scoring. Among patients who underwent hepatectomy, those who responded completely to conversion therapy showed significantly better OS than those who responded partially (HR: 0.40, 95% CI: 0.21-0.75) as well as significantly better EFS (HR: 0.45, 95% CI: 0.29-0.70). Among patients who did not undergo hepatectomy, OS and EFS were comparable between those who responded partially and those who responded completely to conversion therapy. Additionally, locoregional or systemic therapy showed significantly better results in terms of OS and EFS compared to active surveillance. Of the patients who underwent hepatectomy, 116 (38.7%) showed complete pathological response. In patients underwent hepatectomy, those who experienced complete pathological response showed significantly better OS than those who did not (HR: 0.34, 95% CI: 0.18-0.65) as well as significantly better recurrence-free survival (HR: 0.38, 95% CI: 0.25-0.59).

CONCLUSIONS

Hepatectomy can provide a significant OS benefit to patients with initially unresectable HCC that responds partially or completely to conversion therapy.

摘要

引言

对于肝切除术是否能改善初始不可切除的肝细胞癌（HCC）经转化治疗后可切除患者的预后，目前仍存在不确定性。本研究对转化治疗完全或部分缓解后接受肝切除术和未接受肝切除术患者的生存率进行了比较分析。

方法

这项回顾性研究纳入了2019年至2023年期间来自20家中国医疗中心的300例经转化治疗后接受肝切除术的HCC患者，以及265例非手术对照患者（215例接受局部/全身治疗，50例接受主动监测）。评估的主要结局包括总生存期（OS）、无事件生存期（EFS）、无复发生存期和完全病理缓解率。

结果

肝切除术组的OS显著优于局部或全身治疗组或主动监测组（3年OS率分别为79.9%和58.5%，<0.001），但EFS相当（中位数：40.6个月对33.4个月，=0.403）。在根据倾向评分相互匹配的亚组分析后，这些结果得到了证实。在接受肝切除术的患者中，转化治疗完全缓解者的OS显著优于部分缓解者（HR：0.40，95%CI：0.21-0.75），EFS也显著更好（HR：0.45，95%CI：0.29-0.70）。在未接受肝切除术的患者中，转化治疗部分缓解者和完全缓解者的OS和EFS相当。此外，局部或全身治疗在OS和EFS方面的结果显著优于主动监测。在接受肝切除术的患者中，116例（38.7%）显示完全病理缓解。在接受肝切除术的患者中，出现完全病理缓解者的OS显著优于未出现者（HR：0.34，95%CI：0.18-0.65），无复发生存期也显著更好（HR：0.38，95%CI：0.25-0.59）。