在接受仑伐替尼联合PD-1抗体治疗的不可切除肝细胞癌患者肝切除术前行门静脉栓塞术的研究  

The use of portal vein embolization combined with lenvatinib and a PD-1 inhibitor to treat patients with initially unresectable hepatocellular carcinoma

作　　者：徐彬 李小龙 朱小东 黄成 沈英皓 瞿旭东 李美龄 诸金金 汤钊猷 周俭 樊嘉 孙惠川 Xu Bin;Li Xiaolong;Zhu Xiaodong;Huang Cheng;Shen Yinghao;Qu Xudong;Li Meiling;Zhu Jinjin;Tang Zhaoyou;Zhou Jian;Fan Jia;Sun Huichuan(Department of Liver Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Thoracic Surgery,Shanghai General Hospital,Shanghai 200080,China;Department of Interventional Radiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院肝肿瘤外科,上海200032 [2]上海市第一人民医院胸外科,上海200080 [3]复旦大学附属中山医院介入治疗科,上海200032

出　　处：《中华肝胆外科杂志》2022年第1期21-27,共7页Chinese Journal of Hepatobiliary Surgery

基　　金：国家重点基础研究发展规划(973计划)项目(2015CB554005);国家自然科学基金(81372655、81472224、81672326);上海市优秀学术/技术带头人计划(17XD1401100)。

摘　　要：目的:探究肝切除术前行门静脉栓塞术(PVE)在接受仑伐替尼联合程序性死亡蛋白-1(PD-1)抗体治疗的不可切除肝细胞癌患者中的安全性和临床结果。方法:回顾性分析2019年5月至2020年11月复旦大学附属中山医院肝肿瘤外科在肝切除术前接受仑伐替尼联合PD-1抗体治疗及PVE的不可切除肝细胞癌6例患者资料,均为男性,年龄(54.6±6.2)岁,年龄范围46~63岁。每2个月(±2周)通过影像学检查并依据实体瘤临床疗效评价标准(1.1版本)评估肿瘤缓解情况和剩余肝体积。采用门诊复查和电话方式进行随访,了解患者生存和肿瘤进展情况。结果:6例患者在治疗前3例为巴塞罗那临床肝癌分期A期,3例为B期。肝切除术前,1例患者达到部分缓解,5例患者疾病稳定。6例患者行PVE及仑伐替尼联合PD-1抗体治疗前剩余肝体积百分比(29.0±8.9)%,肝切除术前末次评估剩余肝体积百分比(41.3±10.8)%,差异有统计学意义(t=10.79,P<0.001)。5例患者行肝切除,1例患者剩余肝体积增长不足至末次评估未行肝切除。5例行肝切除的患者中1例发生肝切除术后肝衰竭(B级)和严重术后并发症(需要经皮胸腔穿刺引流的胸腔积液)。随访时间范围1.0~12.3个月,中位数4.5个月,5例肝切除患者均无瘤生存。结论:在接受仑伐替尼联合PD-1抗体治疗的不可切除肝细胞癌患者中,肝切除术前行PVE安全可行。Objective To study the safety and treatment outcomes of portal vein embolization(PVE)combined with lenvatinib plus an anti-programmed death-1(PD-1)antibody to treat patients with initially unreasectable hepatocellular carcinoma(uHCC).Methods This study retrospectively analyzed the data of six patients with uHCC who received first-line combined systemic therapy with lenvatinib plus an anti-PD-1 antibody,and then underwent pre-hepatectomy PVE at the Department of Liver Surgery at Zhongshan Hospital,Fudan University from May 2019 to November 2020.All enrolled patients were males,aged(54.6±6.2)(ranged 46 to 63)years.Tumor response and liver volume were evaluated by medical imagings once every 2 months(±2 weeks)and evaluated using the Response Evaluation Criteria in Solid Tumours(version 1.1).Patients were followed-up by outpatient interviews or by phone calls to record their survival and tumor outcome status.Results Three of the six enrolled patients had Barcelona Clinic Liver Cancer stage A and three had stage B disease.One patient achieved a partial response and five patients had stable diseases.The mean±s.d.future liver remnant(FLR)percentage was(29.0±8.9)%before PVE and the combination therapy,and was(41.3±10.8)%before the last evaluation for liver surgery(t=10.79,P<0.001).Hepatectomy was carried out in five patients,and one patient who failed to develop significant FLR hypertrophy did not undergo hepatectomy.Grade B post-hepatectomy liver failure and major postoperative complications(i.e.pleural effusion requiring additional percutaneous drainage)occurred in one patient.After a median post-operative follow-up of 4.5(range:1.0-12.3)months,all five patients were alive and were tumor free.Conclusion PVE followed by hepatectomy is feasible in a uHCC patients receiving systemic therapy with lenvatinib and an anti-PD-1 antibody.

关 键 词：癌 肝细胞 肝切除术 门静脉栓塞术 仑伐替尼 程序性死亡蛋白-1抗体 

分 类 号：R735.7[医药卫生—肿瘤]