Application of targeted therapy in postoperative adjuvant therapy for hepatocellular carcinoma complicated with portal vein tumor thrombus

doi:10.3877/cma.j.issn.2095-3232.2021.03.008

Abstract

Abstract:

Objective

To evaluate the application of targeted therapy in postoperative adjuvant therapy for hepatocellular carcinoma (HCC) complicated with portal vein tumor thrombus (PVTT).

Methods

Clinical data of 35 HCC patients complicated with PVTT admitted to Shanghai Eastern Hepatobiliary Surgery Hospital from January 2016 to June 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 31 patients were male and 4 female, aged from 36 to 70 years, with a median age of 53 years. According to postoperative use of targeted drugs, all patients were divided into the targeted group (n=19) and control group (n=16). Survival analysis was performed by Kaplan-Meier method and Log-rank test. Cox's proportional hazards regression model was used for univariate and multivariate analyses.

Results

In the targeted group, sorafenib was given in 12 patients, lenvatinib in 6 cases and apatinib in 1 case. The postoperative 1-, 2- and 3-year survival rates in the targeted group were 73.3%, 66.6% and 53.3%, and were 60.0%, 10.9% and 10.9% accordingly in the control group. The postoperative overall survival rate in the targeted group was significantly better than that in the control group (HR=0.32, P<0.05). Multivariate analysis demonstrated that postoperative targeted therapy wasan independent protective factor affecting the postoperative overall survival of HCC patients complicated with PVTT (HR=0.35, 95%CI: 0.13-0.95; P<0.05).

Conclusion

Postoperative adjuvant therapy using targeted drug can significantly improve the overall survival of HCC patients complicated with PVTT.

Key words: Carcinoma, hepatocellular, Portal vein, Neoplastic cells, circulating, Targeted therapy

Kai Yan, Wenfeng Lu, Yong Fu, Peiqin Chen, Zhuding Xu, Haibin Zhang. Application of targeted therapy in postoperative adjuvant therapy for hepatocellular carcinoma complicated with portal vein tumor thrombus[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(03): 269-273.

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References 20

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组别	例数	年龄（岁，±s）	性别（例，男/女）	HBsAg阳性（例）	HBV-DNA阳性（例）	抗-HCV阳性（例）	AFP≥400 μg/L（例）	异常凝血酶原>40 mAU/ml（例）	Plt（×10⁹/L，±s）	合并肝硬化（例）
靶向组	19	51±2	18/1	18	6	0	7	15	145±9	13
对照组	16	53±2	13/3	15	9	1	11	9	179±29	8
统计值		t=-1.414	χ²=2.594	χ²=0.016	χ²=2.159	-	χ²=3.540	χ²=4.219	t=-1.196	χ²=1.228
P值		0.496	0.212	0.900	0.142	0.209	0.060	0.040	0.619	0.268
组别	肿瘤最大直径（cm，±s）	癌栓分型（例）				手术方式（例）		术后并发症（例）		随访时间[月，M（Q_R）]
组别	肿瘤最大直径（cm，±s）	vp1	vp2	vp3	vp4	区域性肝切除术	门静脉癌栓取出术	肝衰竭	胆漏	随访时间[月，M（Q_R）]
靶向组	7.2±0.7	3	7	8	1	5	14	0	1	20（13）
对照组	6.0±0.5	6	4	6	0	6	10	1	0	38（25）
统计值	t=1.351	-				χ²=0.504		-	-	U=-85.5
P值	0.203	0.412				0.478		0.209	0.352	0.585

组别	例数	年龄（岁，±s）	性别（例，男/女）	HBsAg阳性（例）	HBV-DNA阳性（例）	抗-HCV阳性（例）	AFP≥400 μg/L（例）	异常凝血酶原>40 mAU/ml（例）	Plt（×10⁹/L，±s）	合并肝硬化（例）
靶向组	19	51±2	18/1	18	6	0	7	15	145±9	13
对照组	16	53±2	13/3	15	9	1	11	9	179±29	8
统计值		t=-1.414	χ²=2.594	χ²=0.016	χ²=2.159	-	χ²=3.540	χ²=4.219	t=-1.196	χ²=1.228
P值		0.496	0.212	0.900	0.142	0.209	0.060	0.040	0.619	0.268
组别	肿瘤最大直径（cm，±s）	癌栓分型（例）				手术方式（例）		术后并发症（例）		随访时间[月，M（Q_R）]
组别	肿瘤最大直径（cm，±s）	vp1	vp2	vp3	vp4	区域性肝切除术	门静脉癌栓取出术	肝衰竭	胆漏	随访时间[月，M（Q_R）]
靶向组	7.2±0.7	3	7	8	1	5	14	0	1	20（13）
对照组	6.0±0.5	6	4	6	0	6	10	1	0	38（25）
统计值	t=1.351	-				χ²=0.504		-	-	U=-85.5
P值	0.203	0.412				0.478		0.209	0.352	0.585

组别	例数	再手术	TACE	放疗	更换靶向药物或开始靶向治疗	PD-1单抗免疫治疗	局部消融
靶向组	17	0	14	4	2	4	0
对照组	14	2	12	1	2	1	2

组别	例数	再手术	TACE	放疗	更换靶向药物或开始靶向治疗	PD-1单抗免疫治疗	局部消融
靶向组	17	0	14	4	2	4	0
对照组	14	2	12	1	2	1	2

影响因素	单因素回归分析			多因素回归分析
影响因素	HR值	95%CI	P值	HR值	95%CI	P值
年龄	0.99	0.93～1.04	0.762
性别男性	1.78	0.58～5.46	0.339
HBV-DNA阳性	0.85	0.32～2.22	0.751
AFP≥400 μg/L	1.18	-2.99～0.46	0.721
Plt	1.01	1.00～1.01	0.041	1.01	1.00～1.01	0.046
肝硬化	0.48	0.18～1.26	0.134
PVTT分型	0.89	0.51～1.53	0.677
术前辅助治疗（TACE、放疗）	0.67	0.08～5.20	0.686
手术方式（PVTT取出术）	0.91	0.33～2.46	0.859
术后靶向治疗	0.32	0.12～0.85	0.023	0.35	0.13～0.95	0.040

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