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Prognostic Impact of Surgical Intervention After Lenvatinib Treatment for Advanced Hepatocellular Carcinoma

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

With the introduction of new molecular-targeted agents, an increasing number of patients with advanced hepatocellular carcinoma (HCC) are benefiting from salvage interventions; however, the actual rate of conversion surgery and its prognostic advantages remain unclear.

Methods

The clinical outcomes of 107 consecutive patients who underwent lenvatinib treatment for advanced HCC were reviewed and the efficacy of additional therapy, including surgery, was investigated.

Results

Of the 107 patients who were initially unsuitable for curative-intent therapy or transarterial chemoembolization (TACE), 54 (50.5%) received further therapy after lenvatinib treatment (surgery [n = 16] and TACE or other treatments [n = 38]). Of the 16 patients who received surgical intervention, R0 resection was achieved in 9 (8.4%) patients. Survival analysis confirmed that successful conversion to R0 resection was associated with a longer time to treatment failure (hazard ratio [HR] 0.04, 95% confidence interval [CI] 0.01–0.29; p = 0.002) and better disease-specific survival (HR 0.04, 95% CI 0.01–0.30; p = 0.002) compared with no additional treatment, while additional treatment other than surgery or R2 resection was associated with only a marginal or no prognostic advantage. Multivariate analysis confirmed that a decrease in plasma des-gamma-carboxyprothrombin levels compared with baseline levels (odds ratio 22.22, 95% CI 3.42–144.29; p = 0.001) was significantly correlated with successful R0 resection after lenvatinib treatment, irrespective of the tumor response as assessed by imaging analysis.

Conclusions

In selected patients with advanced HCC, conversion surgery after lenvatinib treatment may offer significant survival benefit as long as R0 resection is achieved.

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Funding

This study was supported by study grants from Okinaka Memorial Institute for Medical Disease.

Author information

Authors and Affiliations

  1. Hepatobiliary-Pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan

    Junichi Shindoh MD, PhD, Yuta Kobayashi MD, PhD, Satoshi Okubo MD, PhD & Masaji Hashimoto MD, PhD

  2. Okinaka Memorial Institute for Medical Disease, Tokyo, Japan

    Junichi Shindoh MD, PhD

  3. Department of Hepatology, Toranomon Hospital, Tokyo, Japan

    Yusuke Kawamura MD, PhD, Masahiro Kobayashi MD, Norio Akuta MD, PhD & Yoshiyuki Suzuki MD, PhD

Authors
  1. Junichi Shindoh MD, PhD
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  2. Yusuke Kawamura MD, PhD
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  3. Yuta Kobayashi MD, PhD
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  4. Masahiro Kobayashi MD
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  5. Norio Akuta MD, PhD
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  6. Satoshi Okubo MD, PhD
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  7. Yoshiyuki Suzuki MD, PhD
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  8. Masaji Hashimoto MD, PhD
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Corresponding author

Correspondence to Junichi Shindoh MD, PhD.

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Disclosures

Junichi Shindoh and Yusuke Kawamura receive honoraria from Eisai Pharmaceutical Co., Ltd. Yuta Kobayashi, Masahiro Kobayashi, Norio Akuta, Satoshi Okubo, Yoshiyuki Suzuki, and Masaji Hashimoto have no conflicts of interest to declare.

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Supplementary Fig. 1

Kinetics of plasma des-gamma-carboxyprotrombin (DCP) levels (a) and serum α-fetoprotein (AFP) levels (b) in the surgical cohort after intensive treatment with lenvatinib. Black lines represent R0 resection cases and dotted lines represent R2 resection cases (PPTX 135 KB)

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Shindoh, J., Kawamura, Y., Kobayashi, Y. et al. Prognostic Impact of Surgical Intervention After Lenvatinib Treatment for Advanced Hepatocellular Carcinoma. Ann Surg Oncol 28, 7663–7672 (2021). https://doi.org/10.1245/s10434-021-09974-0

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  • DOI: https://doi.org/10.1245/s10434-021-09974-0

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