Alternating Lenvatinib and Trans-Arterial Therapy Prolongs Overall Survival in Patients with Inter-Mediate Stage HepatoCellular Carcinoma: A Propensity Score Matching Study
by
, , , , and
Shigeo Shimose
1,*,†
,
Hideki Iwamoto
1,2,*,†,
Masatoshi Tanaka
3,
Takashi Niizeki
1,
Tomotake Shirono
1,
Yu Noda
1,
Naoki Kamachi
1,
Shusuke Okamura
1,
Masahito Nakano
1
,
Hideya Suga
4,
Taizo Yamaguchi
2,
Takumi Kawaguchi
1
,
Ryoko Kuromatsu
1,
Kazunori Noguchi
5,
Hironori Koga
1
and
Takuji Torimura
1 1
Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
2
Department of Gastroenterology and Hepatology, Iwamoto Internal Medical Clinic, Kitakyusyu 802-0832, Japan
3
Department of Gastroenterology and Hepatology, Yokokura Hospital, Miyama, Fukuoka 839-0295, Japan
4
Department of Gastroenterology and Hepatology, Yanagawa Hospital, Fukuoka 832-0077, Japan
5
Department of Gastroenterology and Hepatology, Omuta City Hospital, Fukuoka 836-8567, Japan
*
Authors to whom correspondence should be addressed.
†
These authors (S.S and H.I.) contributed equally to this work as corresponding authors.
Cancers 2021, 13(1), 160; https://doi.org/10.3390/cancers13010160
Submission received: 30 November 2020
/
Revised: 29 December 2020
/
Accepted: 1 January 2021
/
Published: 5 January 2021
(This article belongs to the Special Issue Prognosis and Treatment of Hepatocellular Carcinoma)
Simple Summary
This study aimed to investigate the efficacy of alternating lenvatinib (LEN) and trans-arterial therapy (AT) in patients with intermediate-stage hepatocellular carcinoma (HCC) after propensity score matching analysis. AT and albumin-bilirubin (ALBI) grade 1 were identified as independent factors for overall survival in patients with intermediate-stage HCC. Decision tree analysis demonstrated that the recommended indication of AT was below 70 years of age with ALBI grade 1. This study may reveal clinical features associated with the efficacy of AT and may contribute to improving survival in patients with intermediate-stage HCC.
Abstract
We aimed to evaluate the impact of alternating lenvatinib (LEN) and trans-arterial therapy (AT) in patients with intermediate-stage hepatocellular carcinoma (HCC) after propensity score matching (PSM). This retrospective study enrolled 113 patients with intermediate-stage HCC treated LEN. Patients were classified into the AT (n = 41) or non-AT group (n = 72) according to the post LEN treatment. Overall survival (OS) was calculated using the Kaplan–Meier method and analyzed using a log-rank test after PSM. Factors associated with AT were evaluated using a decision tree analysis. After PSM, there were no significant differences in age, sex, etiology, or albumin-bilirubin (ALBI) score/grade between groups. The survival rate of the AT group was significantly higher than that of the non-AT group (median survival time; not reached vs. 16.3 months, P = 0.01). Independent factors associated with OS were AT and ALBI grade 1 in the Cox regression analysis. In the decision tree analysis, age and ALBI were the first and second splitting variables for AT. In this study, we show that AT may improve prognosis in patients with intermediate-stage HCC. Moreover, alternating LEN and trans-arterial therapy may be recommended for patients below 70 years of age with ALBI grade 1.
Keywords:
lenvatinib; alternating therapy; intermediate stage; TACE; HAIC
