Criteria for identifying potentially resectable patients with initially oncologically unresectable hepatocellular carcinoma before treatment with lenvatinib plus an anti-PD-1 antibody.
Criteria for identifying potentially resectable patients with initially oncologically unresectable hepatocellular carcinoma before treatment with lenvatinib plus an anti-PD-1 antibody.
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在接受乐伐替尼联合抗 PD-1 抗体治疗之前，识别最初肿瘤学上不可切除的肝细胞癌患者的潜在可切除标准
DOI：
10.3389/fimmu.2022.1016736
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发表时间：
2022
影响因子：
7.3
通讯作者：
中科院分区：
文献类型：
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作者：
对于肿瘤学上不能切除的肝细胞癌（HCC）患者，转换治疗是可行的。然而，在开始全身治疗（单独或联合局部治疗）之前，前瞻性识别更有可能成功转换的患者具有挑战性。基于真实世界证据，提出了在乐伐替尼联合抗PD-1抗体治疗前识别最初肿瘤学不可切除HCC的潜在可切除患者的标准。在2018年9月至2021年9月期间接受乐伐替尼联合抗PD-1抗体治疗的晚期HCC连续患者的回顾性队列中，使用多变量Firth logistic回归验证了拟定标准。建议的标准如下：（1）美国东部肿瘤协作组体力状态为0或1分;（2）Child-Pugh A级;（3）局限于一侧肝叶的肝内肿瘤（左叶、右叶或中叶），或存在于一个肝叶中，旁边有一个直径≤5 cm的肿瘤，或在其余肝叶中最多有三个直径≤3 cm的肿瘤，通过半肝切除术可实现R 0切除，（4）门静脉癌栓未累及对侧肝叶或到达上级肠系膜静脉，肝静脉癌栓未累及肿瘤侧2条以上肝静脉主干，下腔静脉癌栓未到达心房。Firth logistic回归证实，这些标准是乐伐替尼加抗PD-1抗体转换治疗后手术的独立预测因素。这项研究提出并验证了识别最初患有肿瘤学不可切除的HCC患者的标准，这些患者在接受乐伐替尼加抗PD-1抗体联合治疗时可能可以切除。建议的标准可以帮助标准化晚期HCC的转换治疗研究。
Conversion therapy is feasible in patients with oncologically unresectable hepatocellular carcinoma (HCC). However, it is challenging to prospectively identify patients who are more likely to achieve successful conversion before initiating systemic therapy, either alone or combined with locoregional therapy. Criteria for identifying potentially resectable patients with initially oncologically unresectable HCC before treatment with lenvatinib plus an anti-PD-1 antibody were proposed based on real-world evidence. Multivariate Firth logistic regression was used to validate the proposed criteria in a retrospective cohort of consecutive patients with advanced HCC, who received combination therapy with lenvatinib plus an anti-PD-1 antibody between September 2018 and September 2021. The proposed criteria were as follows: (1) Eastern Cooperative Oncology Group performance status of 0 or 1; (2) Child-Pugh class A; (3) intrahepatic tumors confined to one lobe (left, right, or middle lobe), or present in one lobe alongside a single tumor with diameter ≤5 cm or up to three tumors each with diameter ≤3 cm in the remaining lobes, with R0 resection achievable by hemihepatectomy, alone or combined with locoregional therapy to the remaining lobes during surgery; and (4) no portal vein tumor thrombus involving the contralateral liver lobe or reaching the superior mesenteric vein, no hepatic vein tumor thrombus involving more than two major hepatic vein branches on the tumor side, and no tumor thrombus of the inferior vena cava reaching the atrium. Firth logistic regression confirmed the criteria were an independent predictor of surgery following conversion therapy with lenvatinib plus an anti-PD-1 antibody. This study proposed and validated criteria for identifying patients with initially oncologically unresectable HCC who are potentially resectable when treated with combination therapy with lenvatinib plus an anti-PD-1 antibody. The proposed criteria could help standardize conversion therapy studies in advanced HCC.
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影响因子：
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影响因子：
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