Hou Yu-Chao, Feng Jin-Kai, Wang Kang, Lou Zhen-Bang, Wei Qian, Wang Xu, Tang Ying-Jue, Liu Zong-Han, Xiang Yan-Jun, Mao Fei-Fei, Gong Lin, Cheng Shu-Qun
Cancer Center, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China.
Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, People's Republic of China.
Oncologist. 2025 Jun 4;30(6). doi: 10.1093/oncolo/oyaf139.
Microvascular invasion (MVI) is a critical prognostic factor affecting long-term survival in patients with hepatocellular carcinoma (HCC). Despite its clinical significance, the optimal postoperative adjuvant therapy for HCC patients with MVI remains undefined. This study aimed to evaluate the efficacy and safety of postoperative adjuvant transarterial chemoembolization (PA-TACE) combined with lenvatinib vs PA-TACE alone in HCC patients with MVI.
We conducted a retrospective analysis of consecutive HCC patients with MVI who underwent curative-intent resection followed by either PA-TACE alone or PA-TACE plus lenvatinib between 2018 and 2022. To ensure comparability, baseline characteristics were balanced using 1:1 propensity-score matching (PSM). The study outcomes, overall survival (OS) and recurrence-free survival (RFS), were compared between the two treatment groups.
The study included 192 patients, with 106 in the PA-TACE alone group and 86 in the PA-TACE plus lenvatinib group. After PSM, 66 matched pairs were analyzed. The median OS and RFS in the PA-TACE plus lenvatinib group were significantly longer than those in the PA-TACE alone group (43.6 months vs 24.0 months, P = 0.015; and 19.6 months vs 10.2 months, P = 0.025, respectively). Multivariable analysis confirmed that PA-TACE plus lenvatinib was an independent protective factor for both OS and RFS.
The combination of PA-TACE and lenvatinib significantly improves survival outcomes in HCC patients with MVI following curative liver resection compared to PA-TACE alone. These findings suggest that this combined approach may be a more effective adjuvant therapy for this high-risk patient population. Further studies are necessary to validate these results and establish clinical guidelines.
微血管侵犯（MVI）是影响肝细胞癌（HCC）患者长期生存的关键预后因素。尽管其具有临床意义，但MVI的HCC患者术后最佳辅助治疗仍不明确。本研究旨在评估术后辅助性经动脉化疗栓塞术（PA-TACE）联合乐伐替尼与单纯PA-TACE相比，在MVI的HCC患者中的疗效和安全性。
我们对2018年至2022年间接受根治性切除，随后接受单纯PA-TACE或PA-TACE加乐伐替尼治疗的连续性MVI的HCC患者进行了回顾性分析。为确保可比性，使用1:1倾向评分匹配（PSM）平衡基线特征。比较两个治疗组的研究结局，即总生存期（OS）和无复发生存期（RFS）。
该研究纳入了192例患者，单纯PA-TACE组106例，PA-TACE加乐伐替尼组86例。PSM后，分析了66对匹配病例。PA-TACE加乐伐替尼组的中位OS和RFS显著长于单纯PA-TACE组（分别为43.6个月对24.0个月，P = 0.015；19.6个月对10.2个月，P = 0.025）。多变量分析证实，PA-TACE加乐伐替尼是OS和RFS的独立保护因素。
与单纯PA-TACE相比，PA-TACE联合乐伐替尼可显著改善根治性肝切除术后MVI的HCC患者的生存结局。这些发现表明，这种联合方法可能是针对这一高危患者群体更有效的辅助治疗。需要进一步研究以验证这些结果并建立临床指南。
