Surgical and Oncological Outcomes of Conversion Surgery After Hepatic Arterial Infusion Chemotherapy for Initially Unresectable Locally Advanced Hepatocellular Carcinoma

IF 3.3 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Yuichi Goto, Yutaro Mihara, Takashi Niizeki, Hisamune Sakai, Sachiko Ogasawara, Jun Akiba, Hirohisa Yano, Takumi Kawaguchi, Fumihiko Fujita, Toru Hisaka
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Abstract

Background

Since 2013, we have performed conversion surgery after hepatic arterial infusion chemotherapy (HAIC) for initially unresectable locally advanced hepatocellular carcinoma (LA-HCC).

Methods

Between 2013 and 2021, we assessed the surgical and oncological outcomes and pathological findings of patients with LA-HCC without extrahepatic spread (EHS) whose tumors converted from unresectable to resectable status with the New-FP regimen HAIC.

Results

We censored 153 patients with LA-HCC (Child-Pugh A, without EHS) indicated for HAIC. Among them, 25 converted to resectable status after HAIC. Antitumoral effects were Response Evaluation Criteria in Solid Tumors (RECIST) partial response in 13/25 cases (52%) and modified RECIST complete response in 14/25 cases (56%). We performed hepatectomy for 24 cases because one case was lost to unexpected liver failure after portal vein embolization. No severe complications were recorded after hepatectomy. The 5-year overall survival rate was 56%. When resected specimens were assessed as whole tissue sections, all showed various degrees of necrosis (median rate of necrotic nodules: 90%), and 7 had complete necrosis. We also classified patterns of residual tumors into intratumoral and peritumoral types, with the former divided into a peripheral and a nonperipheral type. All cases with complete necrosis survived, and recurrence of the peripheral type was less frequent than other residual patterns (p = 0.0451). All patients whose residual tumors contained a peritumoral pattern experienced recurrence within roughly 12 months.

Conclusions

New-FP regimen HAIC achieved favorable surgical and oncological outcomes and could be adopted as a conversion chemotherapy. In addition, different residual tumor patterns demonstrated different prognoses.

Abstract Image

最初不可切除的局部晚期肝细胞癌肝动脉输注化疗后转换手术的外科和肿瘤学结果
自2013年以来,我们为最初无法切除的局部晚期肝细胞癌(LA-HCC)进行肝动脉输注化疗(HAIC)后的转化手术。方法在2013年至2021年期间,我们评估了未发生肝外扩散(EHS)的LA-HCC患者的手术和肿瘤预后以及病理结果,这些患者的肿瘤通过新fp方案HAIC从不可切除转为可切除。结果153例LA-HCC (Child-Pugh A,无EHS)患者需行HAIC。其中25例经HAIC后转为可切除状态。抗肿瘤效果为实体瘤反应评价标准(RECIST), 13/25例(52%)部分缓解,14/25例(56%)改良RECIST完全缓解。我们对24例患者行肝切除术,其中1例因门静脉栓塞后意外肝衰竭而丢失。肝切除术后无严重并发症。5年总生存率为56%。当切除标本作为整个组织切片评估时,所有标本均显示不同程度的坏死(坏死结节的中位率为90%),其中7例为完全坏死。我们还将残留肿瘤的类型分为肿瘤内型和肿瘤周围型,前者分为外周型和非外周型。所有完全坏死的病例均存活,外周型的复发率低于其他残余型(p = 0.0451)。所有残余肿瘤包含瘤周模式的患者在大约12个月内复发。结论新fp方案HAIC取得了良好的手术和肿瘤效果,可作为一种转换化疗方案。此外,不同的残余肿瘤类型表现出不同的预后。
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来源期刊
Annals of Gastroenterological Surgery
Annals of Gastroenterological Surgery GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.30
自引率
11.10%
发文量
98
审稿时长
11 weeks
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