Prognosis of Hepatectomy versus Systemic Chemotherapy Based on Oncological Resectability Criteria for Borderline Resectable Hepatocellular Carcinoma.

IF 11.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Liver Cancer Pub Date : 2025-06-10 DOI:10.1159/000546830

Shohei Komatsu, Toshifumi Tada, Takashi Nishimura, Motofumi Tanaka, Atsushi Takebe, Saeko Kushida, Yoshimi Fujishima, Nobuaki Ishihara, Takanori Matsuura, Ikuo Nakamura, Taro Okazaki, Masahiro Tsuda, Jun Ishida, Ippei Matsumoto, Seiko Hirono, Hirayuki Enomoto, Yuzo Kodama, Takumi Fukumoto

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引用次数: 0

Abstract

Introduction: Oncological resectability criteria for hepatocellular carcinoma have been defined (resectable [R]/borderline resectable 1 [BR1]/borderline resectable 2 [BR2]); however, their validation is necessary.

Methods: A total of 1,469 patients who underwent hepatectomy and 525 patients who received systemic chemotherapy, including lenvatinib, atezolizumab plus bevacizumab, and durvalumab plus tremelimumab, as first-line treatment were analyzed.

Results: In the BR1 group, the median survival times (MSTs) of patients who underwent hepatectomy and systemic chemotherapy were 52.7 and 34.6 months, respectively, without a significant difference (p = 0.075). In the propensity score matching (PSM) analysis of the BR1 group, the MSTs of hepatectomy and systemic chemotherapy were 42.4 and 35.1 months, respectively, without a significant difference (p = 0.772). Hepatitis virus infection, modified albumin-bilirubin (mALBI) grade 2b + 3, and the presence of extrahepatic metastasis were identified as poor prognostic factors for hepatectomy, whereas mALBI grade 2b + 3 was the only poor prognostic factor for systemic chemotherapy. In the BR2 group, the MSTs of hepatectomy and systemic chemotherapy were 20.1 and 19.5 months, respectively, with significantly better survival for hepatectomy than for systemic chemotherapy (p = 0.017). In the PSM analysis of the BR2 group, the MSTs of hepatectomy and systemic chemotherapy were 20.1 and 21.0 months, respectively, without a significant difference (p = 0.375). Serum alpha-fetoprotein levels≥100, intrahepatic tumor number ≥6, and the presence of extrahepatic metastasis were identified as poor prognostic factors for hepatectomy, whereas female, serum alpha-fetoprotein levels ≥100, mALBI grade 2b + 3, intrahepatic maximal tumor size >5 cm, and the presence of extrahepatic metastasis were identified as poor prognostic factors for systemic chemotherapy.

Conclusion: In the PSM analysis, no significant differences were observed between the BR1 and BR2 groups for hepatectomy and systemic chemotherapy. The intrahepatic tumor number for hepatectomy and the intrahepatic maximal tumor size for systemic chemotherapy are significant risk factors for BR2 patients, highlighting the characteristics of each treatment and the potential for selecting the optimal modality.

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基于可切除肝细胞癌肿瘤可切除标准的肝切除术与全身化疗的预后。

导论：肝癌的肿瘤可切除性标准已经确定（可切除[R]/交界性可切除1 [BR1]/交界性可切除2 [BR2]）；然而，它们的验证是必要的。方法：共分析1469例肝切除术患者和525例接受全身化疗的患者，包括lenvatinib、atezolizumab + bevacizumab、durvalumab + tremelimumab作为一线治疗。结果：BR1组患者行肝切除术和全身化疗的中位生存时间（MSTs）分别为52.7个月和34.6个月，差异无统计学意义（p = 0.075）。在BR1组的倾向评分匹配（PSM）分析中，肝切除术和全身化疗的MSTs分别为42.4个月和35.1个月，差异无统计学意义（p = 0.772）。肝炎病毒感染、改良白蛋白-胆红素（mALBI） 2b + 3级和肝外转移被认为是肝切除术的不良预后因素，而mALBI 2b + 3级是全身化疗的唯一不良预后因素。BR2组肝切除术和全身化疗的MSTs分别为20.1个月和19.5个月，肝切除术的生存期明显优于全身化疗（p = 0.017）。在PSM分析中，BR2组肝切除术和全身化疗的MSTs分别为20.1个月和21.0个月，差异无统计学意义（p = 0.375）。血清甲胎蛋白≥100、肝内肿瘤数≥6、有无肝外转移被认为是肝切除术预后不良的因素，而女性，血清甲胎蛋白≥100、mALBI分级2b + 3、肝内最大肿瘤大小> ~ 5cm、有无肝外转移被认为是全身化疗预后不良的因素。结论：在PSM分析中，BR1组和BR2组在肝切除术和全身化疗方面无显著差异。肝切除术的肝内肿瘤数和全身化疗的肝内最大肿瘤大小是BR2患者的重要危险因素，突出了每种治疗的特点和选择最佳方式的潜力。

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

Liver Cancer Medicine-Oncology

CiteScore

20.80

自引率

7.20%

发文量

审稿时长

16 weeks

期刊介绍： Liver Cancer is a journal that serves the international community of researchers and clinicians by providing a platform for research results related to the causes, mechanisms, and therapy of liver cancer. It focuses on molecular carcinogenesis, prevention, surveillance, diagnosis, and treatment, including molecular targeted therapy. The journal publishes clinical and translational research in the field of liver cancer in both humans and experimental models. It publishes original and review articles and has an Impact Factor of 13.8. The journal is indexed and abstracted in various platforms including PubMed, PubMed Central, Web of Science, Science Citation Index, Science Citation Index Expanded, Google Scholar, DOAJ, Chemical Abstracts Service, Scopus, Embase, Pathway Studio, and WorldCat.