Yuan Shi, Kai Chen, Xinlin Li, Xiaodong Li, Xu Feng, Xinhua Wu, Shiguai Qi, Zhengrong Shi
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The primary outcomes assessed were median overall survival (mOS), median progression-free survival (mPFS), median duration of response (mDOR), and adverse events (AEs).</p><p><strong>Results: </strong>Patients in the HAIC+Len→LR group demonstrated significantly longer median overall survival (mOS) (40.1 months vs 35.9 months, P=0.001) and median progression-free survival (mPFS) (32.8 months vs 23.8 months, P=0.0023) compared to the LR group. Preoperative complete response (CR) to HAIC was associated with better median duration of response (mDOR) and mOS compared to partial response (PR) (not reached vs 28.9 months, P=0.006; 40.0 vs 29.1 months, P=0.037). Subgroup analysis revealed no significant difference in OS or PFS between the HAIC+Len→LR and LR groups in early Barcelona Clinic Liver Cancer (BCLC) stages. However, in late BCLC stages, the HAIC+Len→LR group exhibited significantly improved OS and PFS (HR 0.471, P=0.016; HR 0.551, P=0.022). Treatment-related grade ≥3 adverse events were comparable between the two groups.</p><p><strong>Conclusion: </strong>For patients with resectable or marginally resectable HCC in the intermediate to advanced stages of BCLC, surgery after neoadjuvant HAIC+Len may offer improved long-term prognosis.</p>","PeriodicalId":15906,"journal":{"name":"Journal of Hepatocellular Carcinoma","volume":"11 ","pages":"2063-2076"},"PeriodicalIF":4.2000,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11514688/pdf/","citationCount":"0","resultStr":"{\"title\":\"Prognosis of Neoadjuvant HAIC and Lenvatinib Followed by Surgery versus Direct Resection for Resectable or Borderline Resectable Hepatocellular Carcinoma: A Real-World Study.\",\"authors\":\"Yuan Shi, Kai Chen, Xinlin Li, Xiaodong Li, Xu Feng, Xinhua Wu, Shiguai Qi, Zhengrong Shi\",\"doi\":\"10.2147/JHC.S480852\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>This research aims to compare the efficacy of neoadjuvant hepatic arterial infusion chemotherapy (HAIC) combined with Lenvatinib (Len) to direct liver resection (LR) in patients with resectable or borderline resectable hepatocellular carcinoma (HCC).</p><p><strong>Methods: </strong>This retrospective study included 154 patients with hepatocellular carcinoma (HCC) treated at the a large-scale hepatocellular carcinoma Research Center between March 2019 and June 2023. Patients were assigned to one of two groups: 63 received neoadjuvant hepatic arterial infusion chemotherapy (HAIC) combined with Lenvatinib followed by liver resection (HAIC+Len→LR), while 91 received direct liver resection (LR). The primary outcomes assessed were median overall survival (mOS), median progression-free survival (mPFS), median duration of response (mDOR), and adverse events (AEs).</p><p><strong>Results: </strong>Patients in the HAIC+Len→LR group demonstrated significantly longer median overall survival (mOS) (40.1 months vs 35.9 months, P=0.001) and median progression-free survival (mPFS) (32.8 months vs 23.8 months, P=0.0023) compared to the LR group. Preoperative complete response (CR) to HAIC was associated with better median duration of response (mDOR) and mOS compared to partial response (PR) (not reached vs 28.9 months, P=0.006; 40.0 vs 29.1 months, P=0.037). Subgroup analysis revealed no significant difference in OS or PFS between the HAIC+Len→LR and LR groups in early Barcelona Clinic Liver Cancer (BCLC) stages. However, in late BCLC stages, the HAIC+Len→LR group exhibited significantly improved OS and PFS (HR 0.471, P=0.016; HR 0.551, P=0.022). 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引用次数: 0
摘要
目的：本研究旨在比较新辅助肝动脉灌注化疗（HAIC）联合伦伐替尼（Len）与直接肝切除术（LR）对可切除或边缘可切除肝细胞癌（HCC）患者的疗效：这项回顾性研究纳入了2019年3月至2023年6月期间在大型肝细胞癌研究中心接受治疗的154例肝细胞癌（HCC）患者。患者被分配到两组中的一组：63名患者接受新辅助肝动脉灌注化疗（HAIC）联合伦伐替尼，然后进行肝切除术（HAIC+Len→LR），91名患者接受直接肝切除术（LR）。评估的主要结果包括中位总生存期（mOS）、中位无进展生存期（mPFS）、中位应答持续时间（mDOR）和不良事件（AEs）：与LR组相比，HAIC+Len→LR组患者的中位总生存期（mOS）（40.1个月 vs 35.9个月，P=0.001）和中位无进展生存期（mPFS）（32.8个月 vs 23.8个月，P=0.0023）明显更长。与部分反应（PR）相比，对HAIC的术前完全反应（CR）与较好的中位反应持续时间（mDOR）和中位生存期（未达到 vs 28.9个月，P=0.006；40.0 vs 29.1个月，P=0.037）相关。亚组分析显示，在巴塞罗那临床肝癌（BCLC）早期，HAIC+Len→LR组与LR组的OS或PFS无明显差异。然而，在BCLC晚期，HAIC+Len→LR组的OS和PFS显著改善（HR 0.471，P=0.016；HR 0.551，P=0.022）。治疗相关的≥3级不良事件在两组之间不相上下：结论：对于BCLC中晚期可切除或勉强可切除的HCC患者，在新辅助HAIC+Len治疗后进行手术可改善长期预后。
Prognosis of Neoadjuvant HAIC and Lenvatinib Followed by Surgery versus Direct Resection for Resectable or Borderline Resectable Hepatocellular Carcinoma: A Real-World Study.
Purpose: This research aims to compare the efficacy of neoadjuvant hepatic arterial infusion chemotherapy (HAIC) combined with Lenvatinib (Len) to direct liver resection (LR) in patients with resectable or borderline resectable hepatocellular carcinoma (HCC).
Methods: This retrospective study included 154 patients with hepatocellular carcinoma (HCC) treated at the a large-scale hepatocellular carcinoma Research Center between March 2019 and June 2023. Patients were assigned to one of two groups: 63 received neoadjuvant hepatic arterial infusion chemotherapy (HAIC) combined with Lenvatinib followed by liver resection (HAIC+Len→LR), while 91 received direct liver resection (LR). The primary outcomes assessed were median overall survival (mOS), median progression-free survival (mPFS), median duration of response (mDOR), and adverse events (AEs).
Results: Patients in the HAIC+Len→LR group demonstrated significantly longer median overall survival (mOS) (40.1 months vs 35.9 months, P=0.001) and median progression-free survival (mPFS) (32.8 months vs 23.8 months, P=0.0023) compared to the LR group. Preoperative complete response (CR) to HAIC was associated with better median duration of response (mDOR) and mOS compared to partial response (PR) (not reached vs 28.9 months, P=0.006; 40.0 vs 29.1 months, P=0.037). Subgroup analysis revealed no significant difference in OS or PFS between the HAIC+Len→LR and LR groups in early Barcelona Clinic Liver Cancer (BCLC) stages. However, in late BCLC stages, the HAIC+Len→LR group exhibited significantly improved OS and PFS (HR 0.471, P=0.016; HR 0.551, P=0.022). Treatment-related grade ≥3 adverse events were comparable between the two groups.
Conclusion: For patients with resectable or marginally resectable HCC in the intermediate to advanced stages of BCLC, surgery after neoadjuvant HAIC+Len may offer improved long-term prognosis.
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