文章：

晚期肝细胞癌系统性治疗简易亚分类方案建议

A Proposal for a Simple Subclassification of Advanced Hepatocellular Carcinoma in Systemic Treatment

原文发布日期：12 November 2024

DOI: 10.3390/cancers16223797

类型: Article

开放获取: 是

英文摘要：

Objectives: This study focused on the presence or absence of vascular invasion and extrahepatic metastasis in hepatocellular carcinoma (HCC) and examined their impact on systemic treatment outcomes. Methods: We retrospectively analyzed 362 patients with unresectable HCC who received first-line systemic therapy. The prognostic evaluation was based on the presence of vascular invasion and extrahepatic metastasis at the time of treatment initiation. Results: Patients with vascular invasion or extrahepatic metastasis (advanced group) had significantly worse outcomes than those without these features (intermediate group), with median survival times of 434 and 658 days, respectively. Further subdivision of the advanced group into three categories—patients with only extrahepatic metastasis (m group, n = 77), patients with only vascular invasion (v group, n = 78), and patients with both vascular invasion and extrahepatic metastasis (vm group, n = 52)—revealed that the m group had significantly better outcomes than those in the other two groups, with median survival times of 649, 323, and 187 days, respectively. A comparison of the clinical backgrounds among the three groups demonstrated that the m group had significantly better liver function at the time of treatment initiation than that in the other two groups. Multivariable analysis, including performance status, Child–Pugh score, and the use of immune checkpoint inhibitors as first-line therapy, identified the m group as an independent and significant prognostic factor (hazard ratio, 0.50). Conclusions: Unresectable HCC with extrahepatic metastasis and no vascular invasion represents a novel staging category for systemic treatment.

摘要翻译： 

目的：本研究聚焦于肝细胞癌（HCC）是否存在血管侵犯和肝外转移，并探讨其对全身治疗结局的影响。方法：我们回顾性分析了362例接受一线全身治疗的不可切除HCC患者。预后评估基于治疗开始时是否存在血管侵犯和肝外转移。结果：存在血管侵犯或肝外转移的患者（晚期组）的结局显著差于无这些特征的患者（中期组），中位生存期分别为434天和658天。进一步将晚期组细分为三类——仅存在肝外转移的患者（m组，n = 77）、仅存在血管侵犯的患者（v组，n = 78）以及同时存在血管侵犯和肝外转移的患者（vm组，n = 52）——结果显示，m组的结局显著优于其他两组，中位生存期分别为649天、323天和187天。三组间临床背景比较表明，m组在治疗开始时的肝功能显著优于其他两组。多变量分析（包括体能状态、Child–Pugh评分以及一线治疗中免疫检查点抑制剂的使用情况）确定m组是一个独立且显著的预后因素（风险比，0.50）。结论：伴有肝外转移但无血管侵犯的不可切除HCC构成了全身治疗的一个新分期类别。

原文链接：

A Proposal for a Simple Subclassification of Advanced Hepatocellular Carcinoma in Systemic Treatment