Atsushi Hiraoka1, Takashi Kumada2, Masanori Atsukawa3, Masashi Hirooka4, Kunihiko Tsuji5, Toru Ishikawa6, Koichi Takaguchi7, Kazuya Kariyama8, Ei Itobayashi9, Kazuto Tajiri10, Noritomo Shimada11, Hiroshi Shibata12, Hironori Ochi13, Toshifumi Tada2, Hidenori Toyoda2, Kazuhiro Nouso8, Akemi Tsutsui7, Takuya Nagano7, Norio Itokawa5, Korenobu Hayama5, Michitaka Imai6, Kouji Joko13, Hironori Tanaka14, Tsutomu Tamai15, Yohei Koizumi4, Yoichi Hiasa4, Kojiro Michitaka16, Masatoshi Kudo17. 1. Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan, hirage@m.ehime-u.ac.jp. 2. Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Gifu, Japan. 3. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan. 4. Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan. 5. Center of Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan. 6. Department of Gastroenterology, Saiseikai Niigata Daini Hospital, Niigata, Japan. 7. Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu, Japan. 8. Department of Gastroenterology, Okayama City Hospital, Okayama, Japan. 9. Department of Gastroenterology, Asahi General Hospital, Asahi, Japan. 10. Department of Gastroenterology, Toyama University Hospital, Toyama, Japan. 11. Division of Gastroenterology and Hepatology, Otakanomori Hospital, Kashiwa, Japan. 12. Department of Gastroenterology, Tokushima Prefectural Central Hospital, Tokushima, Japan. 13. Hepatobiliary Center, Matsuyama Red Cross Hospital, Matsuyama, Japan. 14. Department of Gastroenterology, Takarazuka City Hospital, Takarazuka, Japan. 15. Department of Gastroenterology, Kagoshima City Hospital, Kagoshima, Japan. 16. Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan. 17. Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan.
Abstract
BACKGROUND/AIM: We evaluated clinical factors related to improved prognosis of unresectable hepatocellular carcinoma patients (u-HCC), who were treated with tyrosine kinase inhibitor (TKI) sequential therapy, including lenvatinib (LEN). MATERIALS/ METHODS: We enrolled 84 u-HCC cases treated with TKIs including LEN from March 2018 to January 2019 (median age 71 years, 63 males, Child-Pugh score (CPS) 5/6/7 = 62/21/1, tumor-node-metastasis stage of Liver Cancer Study Group of Japan 6th (TNM-LCSGJ) II/III/IVa/IVb = 12/30/5/37, Barcelona Clinic Liver Cancer stage B/C = 33:51). Clinical findings at introduction of the initial TKI were retrospectively evaluated. RESULTS: The median albumin-bilirubin (ALBI) score at introduction of the initial TKI (sorafenib [SOR]/LEN = 80/4) was -2.56, and the past number of transarterial catheter chemoembolization was 3 (IQR: 2-5) (second-line: regorafenib [REG]/LEN/SOR = 31/49/4, third-line: LEN/REG = 31:1). The total period of administration with TKIs showed a good relationship with overall survival (OS) (r = 0.946, 95% confidence interval [CI]: 0.918-0.965, p < 0.001). The prognosis of the entire cohort was good (estimated median survival time: 46.4 months, 1-/2-/3-year OS rate [OSR] = 87.7/63.0/57.2%). A modified-ALBI grade (mALBI) of 2b (ALBI score >-2.27) was the only significant factor at the start of the initial TKI for poor prognosis (hazard ratio 2.319, 95% CI: 1.064-5.052, p = 0.034), while CPS (≥6) was not. Although there was no significant difference in TNM-LCSGJ (p = 0.213), the prognosis of patients with mALBI 1/2a (n = 66) showed better prognosis as compared to those with mALBI 2b (n = 18) (1-year/2-year/3-year OSR = 89.1/69.8/66% vs. 82.4/47.1/23.5%, p = 0.029). CONCLUSION: Good hepatic function (mALBI 1/2a) at introduction of the initial TKI is a requirement for improved prognosis of u-HCC undergoing TKI sequential therapy.
BACKGROUND/AIM: We evaluated clinical factors related to improved prognosis of unresectable hepatocellular carcinomapatients (u-HCC), who were treated with tyrosine kinase inhibitor (TKI) sequential therapy, including lenvatinib (LEN). MATERIALS/ METHODS: We enrolled 84 u-HCC cases treated with TKIs including LEN from March 2018 to January 2019 (median age 71 years, 63 males, Child-Pugh score (CPS) 5/6/7 = 62/21/1, tumor-node-metastasis stage of Liver Cancer Study Group of Japan 6th (TNM-LCSGJ) II/III/IVa/IVb = 12/30/5/37, Barcelona Clinic Liver Cancer stage B/C = 33:51). Clinical findings at introduction of the initial TKI were retrospectively evaluated. RESULTS: The median albumin-bilirubin (ALBI) score at introduction of the initial TKI (sorafenib [SOR]/LEN = 80/4) was -2.56, and the past number of transarterial catheter chemoembolization was 3 (IQR: 2-5) (second-line: regorafenib [REG]/LEN/SOR = 31/49/4, third-line: LEN/REG = 31:1). The total period of administration with TKIs showed a good relationship with overall survival (OS) (r = 0.946, 95% confidence interval [CI]: 0.918-0.965, p < 0.001). The prognosis of the entire cohort was good (estimated median survival time: 46.4 months, 1-/2-/3-year OS rate [OSR] = 87.7/63.0/57.2%). A modified-ALBI grade (mALBI) of 2b (ALBI score >-2.27) was the only significant factor at the start of the initial TKI for poor prognosis (hazard ratio 2.319, 95% CI: 1.064-5.052, p = 0.034), while CPS (≥6) was not. Although there was no significant difference in TNM-LCSGJ (p = 0.213), the prognosis of patients with mALBI 1/2a (n = 66) showed better prognosis as compared to those with mALBI 2b (n = 18) (1-year/2-year/3-year OSR = 89.1/69.8/66% vs. 82.4/47.1/23.5%, p = 0.029). CONCLUSION: Good hepatic function (mALBI 1/2a) at introduction of the initial TKI is a requirement for improved prognosis of u-HCC undergoing TKI sequential therapy.
Authors: Samantha Armstrong; Tina Roy; Bhavana Singh; Monika Kulasekaran; Fatima Shaukat; Xue Geng; Hongkun Wang; Petra Prins; Reena C Jha; Marion L Hartley; Aiwu Ruth He Journal: J Cancer Res Clin Oncol Date: 2022-06-30 Impact factor: 4.553