Comparative Outcome Analysis of Lenvatinib Versus Sorafenib for Recurrence of Hepatocellular Carcinoma After Liver Transplantation.

IF 5.3 2区医学 Q1 IMMUNOLOGY

Transplantation Pub Date : 2024-11-06 DOI:10.1097/TP.0000000000005240

Christian T J Magyar, Sheron Perera, Luckshi Rajendran, Zhihao Li, Fahad A Almugbel, Sophie Feng, Woo Jin Choi, Laia Aceituno, Arndt Vogel, Robert C Grant, Nazia Selzner, Elmar Jaeckel, Nazanin Falla-Rad, Jennifer J Knox, Eric X Chen, Gonzalo Sapisochin, Grainne M O'Kane

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引用次数: 0

Abstract

Background: Hepatocellular carcinoma (HCC) recurs after liver transplantation (LT) in ~17% of patients. We aimed to retrospectively compare the outcomes of patients treated with different tyrosine kinase inhibitors (TKIs) for recurrent HCC post-LT.

Methods: Patients with recurrent HCC post-LT between 2006 and 2019 were included. The impact of sorafenib and lenvatinib treatment for recurrent disease was assessed using survival analysis with an a priori multivariable Cox regression (alpha-fetoprotein [AFP] at recurrence, recurrence lesion diameter, single-site versus multisite metastases).

Results: Seven hundred fifty-four patients underwent LT for HCC, of whom 120 (15.9%) developed recurrence. Of these patients, 56 received TKIs: sorafenib (n = 42) or lenvatinib (n = 14). The median age at LT was 60.8 y (interquartile range, 54.0-66.2); 52 (93%) were men and 26 (46%) were within Milan criteria at listing. Baseline characteristics at recurrence were comparable between the 2 groups, including largest tumor diameter (P = 0.15), receipt of local therapies before TKI (P = 0.33), and single-site recurrence (P = 0.75), and time from interventional treatment to start of TKI (P = 0.44). The AFP at recurrence was higher in the sorafenib group (95.0 versus 3.0 µg/L, P < 0.001). The median overall survival (OS) after initiation of TKI treatment was longer in the lenvatinib group (15.0 mo [95% confidence interval [CI], 11.5-31.5] versus 7.8 mo [95% CI, 4.0-15.4]; P = 0.02) with a 2.3-fold a priori adjusted effect on OS (adjusted hazard ratio 2.32 [95% CI, 1.03-5.20], P = 0.04).

Conclusions: Our findings suggest lenvatinib is a valuable treatment option for patients with HCC recurrence after LT.

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伦伐替尼与索拉非尼治疗肝移植后肝细胞癌复发的疗效对比分析

背景：约有17%的患者在肝移植（LT）后复发肝细胞癌（HCC）。我们旨在回顾性比较不同酪氨酸激酶抑制剂（TKIs）治疗LT后复发HCC患者的疗效：方法：纳入2006年至2019年期间LT术后复发的HCC患者。采用先验多变量Cox回归（复发时甲胎蛋白[AFP]、复发病灶直径、单部位转移与多部位转移）生存分析评估索拉非尼和来伐替尼治疗对复发疾病的影响：754名HCC患者接受了LT治疗，其中120人（15.9%）出现复发。其中56名患者接受了TKIs治疗：索拉非尼（42人）或来伐替尼（14人）。LT时的中位年龄为60.8岁（四分位数间距为54.0-66.2）；52人（93%）为男性，26人（46%）符合米兰标准。两组患者复发时的基线特征具有可比性，包括最大肿瘤直径（P = 0.15）、TKI 前接受过局部治疗（P = 0.33）、单部位复发（P = 0.75）以及从介入治疗到开始使用 TKI 的时间（P = 0.44）。索拉非尼组复发时的甲胎蛋白（AFP）更高（95.0µg/L对3.0µg/L，P 结论：索拉非尼组复发时的甲胎蛋白（AFP）更高（95.0µg/L）：我们的研究结果表明，对于LT后HCC复发的患者，来伐替尼是一种有价值的治疗选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation 医学-免疫学

CiteScore

8.50

自引率

11.30%

发文量

1906

审稿时长

1 months

期刊介绍： The official journal of The Transplantation Society, and the International Liver Transplantation Society, Transplantation is published monthly and is the most cited and influential journal in the field, with more than 25,000 citations per year. Transplantation has been the trusted source for extensive and timely coverage of the most important advances in transplantation for over 50 years. The Editors and Editorial Board are an international group of research and clinical leaders that includes many pioneers of the field, representing a diverse range of areas of expertise. This capable editorial team provides thoughtful and thorough peer review, and delivers rapid, careful and insightful editorial evaluation of all manuscripts submitted to the journal. Transplantation is committed to rapid review and publication. The journal remains competitive with a time to first decision of fewer than 21 days. Transplantation was the first in the field to offer CME credit to its peer reviewers for reviews completed. The journal publishes original research articles in original clinical science and original basic science. Short reports bring attention to research at the forefront of the field. Other areas covered include cell therapy and islet transplantation, immunobiology and genomics, and xenotransplantation.