Important Clinical Factors in Sequential Therapy Including Lenvatinib against Unresectable Hepatocellular Carcinoma

被引：76

作者：

Hiraoka, Atsushi ^{[1
]}

Kumada, Takashi ^{[2
]}

Atsukawa, Masanori ^{[3
]}

Hirooka, Masashi ^{[4
]}

Tsuji, Kunihiko ^{[5
]}

Ishikawa, Toru ^{[6
]}

Takaguchi, Koichi ^{[7
]}

Kariyama, Kazuya ^{[8
]}

Itobayashi, Ei ^{[9
]}

Tajiri, Kazuto ^{[10
]}

Shimada, Noritomo ^{[11
]}

Shibata, Hiroshi ^{[12
]}

Ochi, Hironori ^{[13
]}

Tada, Toshifumi ^{[2
]}

Toyoda, Hidenori ^{[2
]}

Nouso, Kazuhiro ^{[8
]}

Tsutsui, Akemi ^{[7
]}

Nagano, Takuya ^{[7
]}

Itokawa, Norio ^{[5
]}

Hayama, Korenobu ^{[5
]}

Imai, Michitaka ^{[6
]}

Joko, Kouji ^{[13
]}

Tanaka, Hironori ^{[14
]}

Tamai, Tsutomu ^{[15
]}

Koizumi, Yohei ^{[4
]}

Hiasa, Yoichi ^{[4
]}

Michitaka, Kojiro ^{[1
]}

Kudo, Masatoshi ^{[16
]}

机构：

[1] Ehime Prefectural Cent Hosp, Gastroenterol Ctr, 83 Kasuga Cho, Matsuyama, Ehime 7900024, Japan

[2] Ogaki Municipal Hosp, Dept Gastroenterol & Hepatol, Gifu, Japan

[3] Nippon Med Sch, Dept Internal Med, Div Gastroenterol & Hepatol, Tokyo, Japan

[4] Ehime Univ, Grad Sch Med, Dept Gastroenterol & Metabol, Toon, Japan

[5] Teine Keijinkai Hosp, Ctr Gastroenterol, Sapporo, Hokkaido, Japan

[6] Saiseikai Niigata Daini Hosp, Dept Gastroenterol, Niigata, Japan

[7] Kagawa Prefectural Cent Hosp, Dept Hepatol, Takamatsu, Kagawa, Japan

[8] Okayama City Hosp, Dept Gastroenterol, Okayama, Japan

[9] Asahi Gen Hosp, Dept Gastroenterol, Asahi, Japan

[10] Toyama Univ Hosp, Dept Gastroenterol, Toyama, Japan

[11] Otakanomori Hosp, Div Gastroenterol & Hepatol, Kashiwa, Chiba, Japan

[12] Tokushima Prefectural Cent Hosp, Dept Gastroenterol, Tokushima, Japan

[13] Matsuyama Red Cross Hosp, Hepatobiliary Ctr, Matsuyama, Ehime, Japan

[14] Takarazuka City Hosp, Dept Gastroenterol, Takarazuka, Hyogo, Japan

[15] Kagoshima City Hosp, Dept Gastroenterol, Kagoshima, Japan

[16] Kindai Univ, Fac Med, Dept Gastroenterol & Hepatol, Osaka, Japan

来源：

ONCOLOGY | 2019年 / 97卷 / 05期

基金：

日本学术振兴会;

关键词：

Hepatocellular carcinoma; Sorafenib; Regorafenib; Lenvatinib; Albumin-bilirubin grade; modified; Sequential therapy; CONTRAST-ENHANCED ULTRASONOGRAPHY; ALBUMIN-BILIRUBIN GRADE; JAPANESE PATIENTS; LIVER-FUNCTION; ALBI GRADE; SORAFENIB; GUIDELINE; PROGNOSIS;

D O I：

10.1159/000501281

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background/Aim: We evaluated clinical factors related to improved prognosis of unresectable hepatocellular carcinoma patients (u-HCC), who were treated with tyrosine kinase inhibitor (TKI) sequential therapy, including lenvatinib (LEN). Materials/Methods: We enrolled 84 u-HCC cases treated with TKIs including LEN from March 2018 to January 2019 (median age 71 years, 63 males, Child-Pugh score (CPS) 5/6/7 = 62/21/1, tumor-node-metastasis stage of Liver Cancer Study Group of Japan 6th (TNM-LCSGJ) II/III/IVa/IVb = 12/30/5/37, Barcelona Clinic Liver Cancer stage B/C = 33:51). Clinical findings at introduction of the initial TKI were retrospectively evaluated. Results: The median albumin-bilirubin (ALBI) score at introduction of the initial TKI (sorafenib [SOR]/LEN = 80/4) was -2.56, and the past number of transarterial catheter chemoembolization was 3 (IQR: 2-5) (second-line: regorafenib [REG]/LEN/SOR = 31/49/4, third-line: LEN/REG = 31:1). The total period of administration with TKIs showed a good relationship with overall survival (OS) (r = 0.946, 95% confidence interval [CI]: 0.918-0.965, p < 0.001). The prognosis of the entire cohort was good (estimated median survival time: 46.4 months, 1-/2-/3-year OS rate [OSR] = 87.7/63.0/57.2%). A modified-ALBI grade (mALBI) of 2b (ALBI score >-2.27) was the only significant factor at the start of the initial TKI for poor prognosis (hazard ratio 2.319, 95% CI: 1.064-5.052, p = 0.034), while CPS (>= 6) was not. Although there was no significant difference in TNM-LCSGJ (p = 0.213), the prognosis of patients with mALBI 1/2a (n = 66) showed better prognosis as compared to those with mALBI 2b (n = 18) (1-year/2-year/3-year OSR = 89.1/69.8/66% vs. 82.4/47.1/23.5%, p = 0.029). Conclusion: Good hepatic function (mALBI 1/2a) at introduction of the initial TKI is a requirement for improved prognosis of u-HCC undergoing TKI sequential therapy.

引用

页码：277 / 285

页数：9

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