Abstract
Simple SummaryThis 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.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.
Highlights
Liver cancer is the third leading cause of cancer-related deaths and the sixth most common neoplasm [1,2]
The prognosis of patients with early-stage Hepatocellular carcinoma (HCC) has been improved by the development of curative therapies [3,4], patients with advanced HCC are usually treated with transcatheter arterial chemoembolization (TACE) [5,6], hepatic arterial infusion chemotherapy (HAIC) [7], molecular-targeted agents (MTAs) [3], and immunotherapy [8] and the prognosis remains poor
Patients who received the arterial therapy (AT) regime comprised 36.2% (41/113) of total patients, and the number of patients treated with TACE, HAIC, and TACE+HAIC was 26, 8, and 7, respectively
Summary
Liver cancer is the third leading cause of cancer-related deaths and the sixth most common neoplasm [1,2]. The prognosis of patients with early-stage HCC has been improved by the development of curative therapies [3,4], patients with advanced HCC are usually treated with transcatheter arterial chemoembolization (TACE) [5,6], hepatic arterial infusion chemotherapy (HAIC) [7], molecular-targeted agents (MTAs) [3], and immunotherapy [8] and the prognosis remains poor. The Barcelona Clinic Liver Cancer staging system is widely used for liver cancer classification. In this system, the intermediate stage is quite board and includes a heterogeneous patient population. Only TACE is recommended for intermediate-stage HCC patients [9,10], MTAs have become available for intermediate-stage HCC patients with preserved liver function [11]. SORA plus HAIC improves overall survival (OS) compared to SORA in patients with HCC [7]
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