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Adjuvant anti-PD-1 antibody for hepatocellular carcinoma with high recurrence risks after hepatectomy

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Abstract

Background and purpose

The clinical role of postoperative adjuvant therapy in hepatocellular carcinoma (HCC) is still unclear. The purpose of our study was to explore the clinical value of postoperative adjuvant anti-programed cell death 1 antibody (PA-PD-1) on the prognosis of HCC patients with high relapse risks after surgery.

Patients and methods

Data of consecutive HCC patients with high recurrence risks treated with liver resection at our center during January 2019 and March 2021 were prospectively collected. Baseline differences were balanced between HCC patients with (PA-PD-1 group) or without PA-PD-1 (non-PD-1 group) after hepatectomy by propensity-score matching (PSM). Between these two groups, we compared overall survival (OS) and recurrence-free survival (RFS). Independent prognostic risk factors for OS and RFS were confirmed by Cox regression analysis, and subgroup analysis was also performed.

Results

47 pairs of patients with or without PD-1 treatment after hepatectomy were matched. After PSM, the 1-year and 2-year RFS was 58.4% and 44.1% in the PA-PD-1 group, and 34.0% and 21.3% in the non-PD-1 group (p = 0.008). The OS at 1 year and 2 years was 91.2% and 91.2% in the PA-PD-1 group, compared with 85.1% and 61.7% in the non-PD-1 group (p = 0.024). Multivariable analyses demonstrated that PA-PD-1 was an independent protective predictor associated with RFS and OS. Through subgroup analysis, we concluded that HCC patients with portal venous tumor thrombus (PVTT) or tumor size ≥ 5 cm significantly benefited from PA-PD-1 therapy in RFS and OS.

Conclusions

Adjuvant anti-PD-1 antibody can effectively improve the survival outcomes of HCC patients with high relapse risks after hepatectomy in this prospective observational study. This finding should be confirmed by results of the ongoing phase 3 randomized controlled trials.

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Data availability

The data used in the study are available from the corresponding author upon reasonable request.

Abbreviations

AFP:

Alpha-fetoprotein

CIs:

Confidence intervals

HCC:

Hepatocellular carcinoma

HRs:

Hazard ratios

HVTT:

Hepatic venous tumor thrombus

MVI:

Microvascular invasion

RFS:

Recurrence-free survival

TACE:

Transarterial chemoembolization

OS:

Overall survival

PA-PD-1:

Postoperative adjuvant anti-programed cell death 1 antibody

PSM:

Propensity-score matching

PVTT:

Portal venous tumor thrombus

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Acknowledgements

Not applicable.

Funding

This study was supported by the National Natural Science Foundation of China (No. 82072029), the National high level talents special support plan—“Ten thousand plan”–Young top-notch talent support program (No. 2019).

Author information

Author notes

  1. Wei Chen, Shuifang Hu, Zelong Liu and Yukun Sun have contributed equally to the manuscript.

Authors and Affiliations

  1. Center of Hepato-Pancreato- Biliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, NO.58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, People’s Republic of China

    Wei Chen & Jian Wu

  2. Department of Pancreaticobiliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China

    Wei Chen

  3. Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-Sen University, NO.58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, People’s Republic of China

    Shuifang Hu, Zelong Liu, Yukun Sun & Zhenwei Peng

  4. Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-Sen University, NO.58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, People’s Republic of China

    Shunli Shen

  5. Institute of Precision Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China

    Zhenwei Peng

  6. Cancer Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China

    Zhenwei Peng

  7. Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China

    Zhenwei Peng

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Contributions

ZW Peng, SL Shen, and J Wu conceived and designed this study; material acquisition, data collection, analysis, and interpretation were carried out by W Chen, SF Hu, ZL Liu, YK Sun, and ZW Peng. The initial draft of the article was written by W Chen, SF Hu, ZL Liu, and YK Sun. And ZW Peng revised it. Final approval of the manuscript was obtained from all authors.

Corresponding authors

Correspondence to Jian Wu, Shunli Shen or Zhenwei Peng.

Ethics declarations

Conflict of interest

Wei Chen, Shuifang Hu, Zelong Liu, Yukun Sun, Jian Wu, Shunli Shen, and Zhenwei Peng declare that they do not have any conflict of interests.

Informed consent in studies with human subjects

All enrolled participants provided written informed consent for data collection and analysis.

Ethical approval

The study was conducted under the guidance of the Declaration of Helsinki (1964) and was approved by the institutional research ethics committee of the First Affiliated Hospital of Sun Yat-sen University.

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Chen, W., Hu, S., Liu, Z. et al. Adjuvant anti-PD-1 antibody for hepatocellular carcinoma with high recurrence risks after hepatectomy. Hepatol Int 17, 406–416 (2023). https://doi.org/10.1007/s12072-022-10478-6

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  • DOI: https://doi.org/10.1007/s12072-022-10478-6

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