Clinical Features and Outcomes of Conversion Therapy in Patients with Unresectable Hepatocellular Carcinoma
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patient Selection and HCC Diagnosis
2.2. Treatment Protocol
2.3. Patient Outcomes
2.4. Hepatic Functional Reserve
2.5. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Treatment Effect
3.3. Baseline Characteristics of the Conversion Cases
3.4. Changes in Tumor Factors in Conversion Cases
3.5. Long-Term Outcomes of the Post-Conversion Case
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | All (n = 244) | Atezo + Bev (n = 113) | LEN (n = 131) | p-Value |
---|---|---|---|---|
Age, median [quartiles], (years) | 73 [67–79] | 73 [68–79] | 73 [47–93] | 0.45 |
Sex (male/female), n | 196/48 | 96/17 | 100/31 | 0.11 |
ECOG-PS (0/1/2), n | 189/41/14 | 82/18/13 | 107/23/1 | 0.52 |
Etiology (HBV/HCV/NBNC), n | 32/94/118 | 13/45/55 | 19/49/63 | 0.21 |
Platelets, median [quartiles], (104/μL) | 15.2 [10.6–18.7] | 15.0 [10.9–18.7] | 16.4 [13.5–19.4] | 0.59 |
M2BpGi [qQuartiles] (C.O.I) | 1.89 [1.06–4.21] | 2.04 [1.06–4.66] | 1.44 [0.95–2.41] | 0.09 |
Child–Pugh score (5/6/7/8), n | 142/80/16/6 | 72/33/6/2 | 70/47/10/4 | 0.27 |
mALBI Grade (1/2a/2b/3), n | 84/66/90/4 | 38/32/39/4 | 46/34/51/0 | 0.51 |
Portal vein invasion (absent/present), n | 192/52 | 87/26 | 105/26 | 0.64 |
Extrahepatic spread (absent/present), n | 171/73 | 77/36 | 94/37 | 0.67 |
AFP, median [quartiles] (ng/mL) | 87 [8–1013] | 82 [8–1229] | 54.5 [8–745] | 0.83 |
BCLC stage (B/C), n | 127/117 | 54/59 | 73/58 | 0.30 |
Treatment line (first-line/second-line/third-line/fourth-line/ fifth-line), n | 156/51/25/8/4 | 70/18/13/8/4 | 86/33/12/0/0 | 0.01 |
Characteristics | All (n = 12) | Atezo + Bev (n = 6) | LEN (n = 6) | p-Value |
---|---|---|---|---|
Age, median [quartiles], (years) | 73 [71–78] | 77 [66–78] | 72 [71–74] | 0.31 |
Sex (male/female), n | 8/4 | 4/2 | 4/2 | 1 |
ECOG-PS (0/1), n | 9/3 | 4/2 | 5/1 | 1 |
Etiology (HBV/HCV/NBNC), n | 0/5/7 | 0/4/2 | 0/1/5 | 0.55 |
Platelets, median [quartiles], (104/μL) | 18.5 [12.1–19.5] | 15.2 [9.8–18.7] | 18.5 [14.2–21.0] | 0.75 |
M2BpGi [quartiles] (C.O.I) | 1.11 [0.97–1.39] | 1.73 [0.99–2.45] | 1.09 [0.97–1.21] | 0.07 |
Child–Pugh score (5/6), n | 9/3 | 5/1 | 4/2 | 1 |
mALBI Grade (1/2a/2b), n | 4/7/1 | 2/4/0 | 2/3/1 | 1 |
Portal vein invasion (absent/present), n | 11/1 | 5/1 | 6/0 | 1 |
Extrahepatic spread (absent/present), n | 12/0 | 6/0 | 6/0 | 1 |
AFP, median [quartiles] (ng/mL) | 13 [5–409] | 84 [5–14] | 13 [8–1231] | 0.93 |
BCLC stage (B/C), n | 11/1 | 5/1 | 6/0 | 1 |
Treatment line (first-line/second-line/third-line/fourth-line), n | 11/0/0/1 | 5/0/0/1 | 6/0/0/0 | 1 |
Variables | Category | No. of Patients (%) | Univariate | |
---|---|---|---|---|
Conversion + | Conversion − | p-Value | ||
Age, (years) | ≥75 | 5 (42) | 97 (42) | 1 |
<75 | 7 (58) | 135 (58) | ||
Sex | Male | 7 (58) | 189 (82) | 0.07 |
Female | 5 (42) | 43 (18) | ||
Etiology | Viral | 5 (42) | 121 (52) | 0.56 |
Non-viral | 7 (68) | 111 (48) | ||
ECOG PS | 1 | 2 (17) | 47 (20) | 1 |
0 | 10 (83) | 185 (80) | ||
mALBI Grade 1+2a | Yes | 11 (92) | 139 (60) | 0.03 |
No | 1 (8) | 93 (40) | ||
Child–Pugh score 5 | Yes | 9 (75) | 134 (58) | 0.37 |
No | 3 (25) | 98 (42) | ||
BCLC stage | B | 11 (92) | 116 (50) | 0.01 |
C | 1 (8) | 116 (50) | ||
AFP level (ng/mL) | ≥400 | 3 (25) | 80 (34) | 0.76 |
<400 | 9 (75) | 152 (66) | ||
Treatment line | First-line | 11 (92) | 145 (62.5) | 0.06 |
Later-line | 1 (8) | 87 (27.5) | ||
Drug therapy | Lenvatinib | 6 (50) | 125 (54) | 0.86 |
Atezo + Bev | 6 (50) | 107 (46) |
Case | AFP (ng/mL) | Tumor Number | Maximum Tumor Size (mm) | BCLC Stage | RECIST Version 1.1 | Treatment Duration (Days) | Treatment Interruption (Days) | Conversion Therapy |
---|---|---|---|---|---|---|---|---|
1 | 13→13 | 5→1 | 23→15 | B→0 | PR | 379 | 7 | MWA |
2 | 6→6 | 4→1 | 51→18 | B→0 | PR | 213 | 10 | MWA |
3 | 1637→5 | 3→1 | 73→35 | B→A | PR | 232 | 7 | Hepatectomy |
4 | 4→4 | 10→1 | 61→41 | B→A | PR | 287 | 64 | Hepatectomy |
5 | 10,950→3660 | 2→2 | 42→25 | B→A | PR | 145 | 9 | MWA |
6 | 11→11 | 1→1 | 64→38 | A→A | PR | 397 | 209 | MWA |
7 | 162→3 | 1→1 | 81→41 | C→C | PR | 168 | 28 | Hepatectomy |
8 | 832→8 | 5→3 | 33→13 | B→A | PR | 210 | 28 | RFA |
9 | 3024→11 | 3→1 | 32→11 | B→0 | PR | 126 | 28 | RFA |
10 | 5→5 | 6→2 | 28→16 | B→A | PR | 105 | 35 | MWA |
11 | 268→76 | 4→1 | 21→13 | B→0 | PR | 210 | 28 | MWA |
12 | 3→3 | 5→3 | 68→23 | B→A | PR | 441 | 35 | MWA |
Median | 88→7 | 4→1 | 47→25 | 211 | 28 |
Case | Conversion Therapy | Continuation of Post-Conversion Drug Therapy | Recurrence | Recurrence Pattern | RFS (Days) | After Treatment |
---|---|---|---|---|---|---|
1 | MWA | + | + | IM | 239 | MTAs |
2 | MWA | + | + | IM | 308 | MWA |
3 | Hepatectomy | - | + | MC | 1357 | MWA |
4 | Hepatectomy | - | + | DM (Bone) | 447 | MTAs |
5 | MWA | + | + | DM (Lymph node) | 657 | MTAs |
6 | MWA | - | + | Local Recurrence | 183 | MWA |
7 | Hepatectomy | - | - | - | 748 | - |
8 | RFA | + | - | - | 575 | - |
9 | RFA | - | + | IM | 167 | RFA |
10 | MWA | - | + | IM | 157 | TACE |
11 | MWA | - | + | IM | 476 | MTAs |
12 | MWA | + | - | - | 68 | - |
Median | 378 |
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Tomonari, T.; Tani, J.; Sato, Y.; Tanaka, H.; Tanaka, T.; Taniguchi, T.; Kawano, Y.; Morishita, A.; Okamoto, K.; Sogabe, M.; et al. Clinical Features and Outcomes of Conversion Therapy in Patients with Unresectable Hepatocellular Carcinoma. Cancers 2023, 15, 5221. https://doi.org/10.3390/cancers15215221
Tomonari T, Tani J, Sato Y, Tanaka H, Tanaka T, Taniguchi T, Kawano Y, Morishita A, Okamoto K, Sogabe M, et al. Clinical Features and Outcomes of Conversion Therapy in Patients with Unresectable Hepatocellular Carcinoma. Cancers. 2023; 15(21):5221. https://doi.org/10.3390/cancers15215221
Chicago/Turabian StyleTomonari, Tetsu, Joji Tani, Yasushi Sato, Hironori Tanaka, Takahiro Tanaka, Tatsuya Taniguchi, Yutaka Kawano, Asahiro Morishita, Koichi Okamoto, Masahiro Sogabe, and et al. 2023. "Clinical Features and Outcomes of Conversion Therapy in Patients with Unresectable Hepatocellular Carcinoma" Cancers 15, no. 21: 5221. https://doi.org/10.3390/cancers15215221