Adaptation of lenvatinib treatment in patients with hepatocellular carcinoma and portal vein tumor thrombosis
Adaptation of lenvatinib treatment in patients with hepatocellular carcinoma and portal vein tumor thrombosis
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DOI：
10.1007/s00280-021-04359-2
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发表时间：
2021-10-10
影响因子：
3
通讯作者：
Igarashi, Yoshinori
中科院分区：
文献类型：
--
作者：
Mukozu, Takanori;Nagai, Hidenari;Igarashi, Yoshinori
目的本研究旨在阐明乐伐替尼治疗肝细胞癌（HCC）伴门静脉癌栓（PVTT）患者的适应性。方法53例原发性肝癌患者接受乐伐替尼治疗。在治疗前后采集血样，通过计算机断层扫描和超声检查患者。在门静脉主干侵犯（Vp 4）的患者中，分析重点是门静脉主干肿瘤导致的闭塞程度。在无主要PVTT（即门静脉主要分支[Vp 3]或Vp 4]受侵）的患者中，通过多普勒分析测量门静脉血流量;然而，多普勒分析难以在患有主要PVTT的患者中进行，因此使用造影剂Sonazoid评价从给予造影剂到其到达门静脉的主要分支的时间（门静脉到达时间）。结果Vp 4组患者的预后明显差于Vp 3组，两个月时Child-Pugh评分明显升高。如果门静脉主干阻塞程度达到或超过70%，则严重PVTT患者的预后较差。在无主要PVTT的患者中，乐伐替尼给药后门静脉血流量显著降低;在有主要PVTT的患者中，肝动脉和门静脉到达时间显著增加。结论门静脉主干高度闭塞的Vp 4患者应避免使用乐伐替尼治疗，因为担心门静脉血流量减少。
Purpose The aim of this study was to clarify the adaptation of lenvatinib treatment in patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT). Method Fifty-three patients with HCC were treated with lenvatinib. Before and after treatment blood sampling, patients were examined by computed tomography and ultrasonography. In patients with portal trunk invasion (Vp4), the analysis focused on the degree of occlusion due to the tumor in the portal trunk. In patients without major PVTT {ie, invasion of the primary branch of the portal vein [Vp3] or Vp4}, portal blood flow volume was measured by Doppler analysis; however, Doppler analysis is difficult to perform in patients with major PVTT, so the time from administration of the contrast agent to when it reached the primary branch of the portal vein (portal vein arrival time) was evaluated with the contrast agent Sonazoid. Results Patients with Vp4 had a significantly worse prognosis than patients with Vp3 and a significant increase in Child-Pugh score at 2 months. Patients with major PVTT had a poor prognosis if the degree of occlusion of the portal trunk was 70% or more. In patients without major PVTT, portal blood flow was significantly decreased after administration of lenvatinib; and in patients with major PVTT, the hepatic artery and portal vein arrival times were significantly increased. Conclusion Lenvatinib treatment should be avoided in patients with Vp4 with a high degree of portal trunk occlusion because of concerns about decreased portal blood flow.