Background: Hepatocellular carcinoma (HCC) larger than 10 cm has a poor prognosis, with high recurrence rates, particularly distant metastases. This study examined whether lenvatinib treatment followed by liver resection improves the outcomes for large HCCs compared with upfront surgery. Methods: We retrospectively analyzed 30 patients with HCC larger than 10 cm who underwent hepatectomy at our institution between January 2008 and December 2023. The study cohort included 30 patients: 9 received preoperative lenvatinib treatment followed by hepatectomy (LEN group), while 21 patients underwent upfront surgery (UFS group). We compared the clinicopathological characteristics, surgical outcomes, recurrence patterns, and survival between the two groups. Results: The median duration of lenvatinib administration was 1.8 months, with partial response in two patients (22.2%) and stable disease in seven patients (77.7%). While lenvatinib treatment significantly decreased serum albumin levels (p< 0.05) and increased ALBI scores (p= 0.03), the surgical outcomes including blood loss, operation time, and complication rates were comparable between the two groups. The 3-year recurrence-free survival rate was significantly higher in the LEN group compared with the UFS group (66.7% vs. 16.1%,p= 0.027). The 3-year overall survival rate was also higher in the LEN group, though not statistically significant (85.7% vs. 56.1%,p= 0.059). Notably, distant metastasis rates were lower in the LEN group compared with the UFS group (11.1% vs. 47.6%,p= 0.10). Conclusions: Preoperative lenvatinib treatment followed by hepatectomy for large HCC (> 10 cm) may reduce recurrence, particularly distant metastases, and potentially improve long-term survival. This approach may be a promising strategy for large HCCs, which traditionally have a poor prognosis with upfront surgery alone.
背景：直径超过10厘米的肝细胞癌（HCC）预后较差，复发率高，尤其易发生远处转移。本研究旨在探讨与直接手术相比，仑伐替尼治疗后行肝切除术是否能改善大肝癌患者的预后。 方法：我们回顾性分析了2008年1月至2023年12月期间在本机构接受肝切除术的30例直径超过10厘米的HCC患者。研究队列包括30例患者：9例接受术前仑伐替尼治疗后行肝切除术（LEN组），21例接受直接手术（UFS组）。我们比较了两组的临床病理特征、手术结果、复发模式和生存情况。 结果：仑伐替尼治疗的中位持续时间为1.8个月，其中2例患者（22.2%）达到部分缓解，7例患者（77.7%）疾病稳定。尽管仑伐替尼治疗显著降低了血清白蛋白水平（p<0.05）并增加了ALBI评分（p=0.03），但两组在手术结果（包括失血量、手术时间和并发症发生率）方面无显著差异。LEN组的3年无复发生存率显著高于UFS组（66.7% vs. 16.1%，p=0.027）。LEN组的3年总生存率也较高，但无统计学意义（85.7% vs. 56.1%，p=0.059）。值得注意的是，LEN组的远处转移率低于UFS组（11.1% vs. 47.6%，p=0.10）。 结论：对于大肝癌（>10厘米），术前仑伐替尼治疗后行肝切除术可能减少复发，尤其是远处转移，并可能改善长期生存。这一策略可能为大肝癌患者提供一种有前景的治疗方案，而传统上仅采用直接手术的预后较差。
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