Hepatectomy After Conversion Therapy Using Tyrosine Kinase Inhibitors Plus Anti-PD-1 Antibody Therapy for Patients with Unresectable Hepatocellular Carcinoma.
Hepatectomy After Conversion Therapy Using Tyrosine Kinase Inhibitors Plus Anti-PD-1 Antibody Therapy for Patients with Unresectable Hepatocellular Carcinoma.
复制标题
不可切除的肝细胞癌患者使用酪氨酸激酶抑制剂联合抗 PD-1 抗体治疗进行转换治疗后的肝切除术
DOI：
10.1245/s10434-022-12530-z
复制
发表时间：
2023-05
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
--
作者：
酪氨酸激酶抑制剂（TKI）联合抗PD-1抗体的联合治疗显示出较高的抗肿瘤疗效，并使不可切除的肝细胞癌（HCC）患者的转化切除成为可能。然而，长期存活率尚未报道。2018年8月至2020年9月期间在作者医院接受TKI/抗PD-1抗体联合治疗作为最初不可切除HCC一线治疗的连续患者队列有资格参加本研究。对全身治疗有反应且符合肝切除标准的患者接受了具有治愈目的的肝切除术。该研究还调查了临床因素与成功转换切除和术后复发的相关性。该研究入组了101例患者，包括24例（23.8%）在开始全身治疗后中位3.9个月（四分位距：2.5-5.9个月）接受R 0切除术的患者。东部肿瘤协作组体能状态为0、肝内肿瘤较少或对全身治疗有放射学反应的患者更有可能接受根治性切除。中位随访期为21.5个月后，肝切除术与良好的总生存率独立相关（风险比[HR]，0.050; 95%置信区间[CI]，0.007-0.365; P = 0.003）。24例行手术治疗的患者，12个月无复发生存率和总生存率分别为75%和95.8%。对系统治疗实现病理完全缓解（n = 10）与切除术后良好的无复发生存率相关，具有显著性趋势（HR，0.345; 95%CI，0.067-1.785; P = 0.187）。最初不可切除的HCC的选定患者可以在用TKI/抗PD-1抗体组合的全身治疗后进行肝切除术。在这项研究中，转换切除术与良好的预后相关。
Combined treatment with tyrosine kinase inhibitors (TKI) plus anti-PD-1 antibodies showed high anti-tumor efficacy and made conversion resection possible for patients with unresectable hepatocellular carcinoma (HCC). However, long-term survival has not been reported. A cohort of consecutive patients who received combined TKI/anti-PD-1 antibodies as first-line treatment for initially unresectable HCC at the authors’ hospital between August 2018 and September 2020 was eligible for this study. Patients who were responding to systemic therapy and met the criteria for hepatectomy underwent liver resection with curative intention. The study also investigated the association of clinical factors with successful conversion resection and postoperative recurrence. The study enrolled 101 patients including 24 patients (23.8 %) who underwent R0 resection a median of 3.9 months (interquartile range: 2.5–5.9 months) after initiation of systemic therapy. Patients with an Eastern cooperative oncology group performance status of 0, fewer intrahepatic tumors, or a radiographic response to systemic therapy were more likely to be able to receive curative resection. After a median follow-up period of 21.5 months, hepatectomy was independently associated with a favorable overall survival (hazard ratio [HR], 0.050; 95 % confidence interval [CI], 0.007–0.365; P = 0.003). For the 24 patients who underwent surgery, the 12-month recurrence-free survival and overall survival rates were respectively 75% and 95.8%. Achieving a pathologic complete response (n = 10) to systemic therapy was associated with a favorable recurrence-free survival after resection, with a trend toward significance (HR, 0.345; 95% CI, 0.067–1.785; P = 0.187). Selected patients with initially unresectable HCC can undergo hepatectomy after systemic therapy with combined TKI/anti-PD-1 antibodies. In this study, conversion resection was associated with a favorable prognosis.
登录
查看更多内容
影响因子：
158.5
作者：
Llovet, Josep M.;Ricci, Sergio;Bruix, Jordi
通讯作者：
Bruix, Jordi
影响因子：
25.7
作者：
Cheng, Ann-Lii;Qin, Shukui;Finn, Richard S.
通讯作者：
Finn, Richard S.
影响因子：
11.5
作者：
Xu, Jianming;Shen, Jie;Wang, Quanren
通讯作者：
Wang, Quanren
影响因子：
45.3
作者：
Finn, Richard S.;Ikeda, Masafumi;Llovet, Josep M.
通讯作者：
Llovet, Josep M.
影响因子：
4.9
作者：
He MK;Liang RB;Zhao Y;Xu YJ;Chen HW;Zhou YM;Lai ZC;Xu L;Wei W;Zhang YJ;Chen MS;Guo RP;Li QJ;Shi M
通讯作者：
Shi M