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Research ArticleClinical Studies

Surgical Intervention After Lenvatinib Treatment in Patients With Advanced Hepatocellular Carcinoma

MASAYUKI OKUNO, ETSURO HATANO, MASAHARU TADA, TAKASHI NISHIMURA, TOMOHIRO OKAMOTO, HIDEAKI SUEOKA, KENJIRO IIDA, IKUO NAKAMURA, HIROKO IIJIMA and SEIKO HIRONO
Anticancer Research April 2024, 44 (4) 1727-1737; DOI: https://doi.org/10.21873/anticanres.16972
MASAYUKI OKUNO
1Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya, Japan;
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ETSURO HATANO
1Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya, Japan;
2Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan;
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  • For correspondence: etsu@kuhp.kyoto-u.ac.jp
MASAHARU TADA
1Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya, Japan;
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TAKASHI NISHIMURA
3Division of Hepatobiliary and Pancreatic Disease, Department of Gastroenterology, Hyogo Medical University, Nishinomiya, Japan
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TOMOHIRO OKAMOTO
1Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya, Japan;
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HIDEAKI SUEOKA
1Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya, Japan;
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KENJIRO IIDA
1Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya, Japan;
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IKUO NAKAMURA
1Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya, Japan;
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HIROKO IIJIMA
3Division of Hepatobiliary and Pancreatic Disease, Department of Gastroenterology, Hyogo Medical University, Nishinomiya, Japan
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SEIKO HIRONO
1Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya, Japan;
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Abstract

Background/Aim: The survival and prognostic factors in patients with advanced hepatocellular carcinoma (HCC) who underwent surgical intervention after lenvatinib treatment is not well-understood. Patients and Methods: Seventy-six patients with advanced HCC who had lenvatinib treatment were retrospectively analyzed. Results: Of 70 patients who were treated with lenvatinib, 14 patients underwent surgical intervention after lenvatinib treatment for 4-28 weeks. Progression-free survival (PFS) was significantly longer in patients who underwent surgical intervention than in patients with non-surgical treatment (median, 8.6 vs. 5.1 months, p=0.019). Non-significantly longer overall survival (OS) was also observed in patients with surgical intervention compared to patients with non-surgical treatment (median, unreached vs. 21.0 months, p=0.206). In patients who underwent surgical intervention, two patients had a partial response, and 12 had stable disease according to RECIST ver. 1.1 criteria. The serum alpha-fetoprotein (AFP) level was significantly lower after lenvatinib treatment than before lenvatinib treatment (median, 19.2 vs. 196.5 ng/ml, p=0.0081). Eleven patients underwent curative surgery with a 14% major postoperative complication (Clavien–Dindo ≥IIIa) rate. Patients who exhibited decreases in AFP levels or maintained AFP levels within the normal range during lenvatinib treatment had significantly longer PFS (median, 8.6 vs. 3.0 months, p=0.0009) and OS (median, unreached vs. 12.4 months, p=0.012) compared to those with persistently elevated AFP levels beyond the normal range. Conclusion: Surgical intervention after lenvatinib treatment for advanced HCC was associated with longer PFS. Patients exhibiting decreased AFP levels or maintaining AFP levels within the normal limit may be suitable candidates for surgical intervention after lenvatinib treatment for advanced HCC.

Key Words:
  • Advanced stage
  • alpha-fetoprotein
  • borderline resectable
  • conversion
  • intermediate stage
  • Received January 15, 2024.
  • Revision received February 1, 2024.
  • Accepted February 2, 2024.
  • Copyright © 2024 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.
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Surgical Intervention After Lenvatinib Treatment in Patients With Advanced Hepatocellular Carcinoma
MASAYUKI OKUNO, ETSURO HATANO, MASAHARU TADA, TAKASHI NISHIMURA, TOMOHIRO OKAMOTO, HIDEAKI SUEOKA, KENJIRO IIDA, IKUO NAKAMURA, HIROKO IIJIMA, SEIKO HIRONO
Anticancer Research Apr 2024, 44 (4) 1727-1737; DOI: 10.21873/anticanres.16972

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Surgical Intervention After Lenvatinib Treatment in Patients With Advanced Hepatocellular Carcinoma
MASAYUKI OKUNO, ETSURO HATANO, MASAHARU TADA, TAKASHI NISHIMURA, TOMOHIRO OKAMOTO, HIDEAKI SUEOKA, KENJIRO IIDA, IKUO NAKAMURA, HIROKO IIJIMA, SEIKO HIRONO
Anticancer Research Apr 2024, 44 (4) 1727-1737; DOI: 10.21873/anticanres.16972
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Keywords

  • Advanced stage
  • alpha-fetoprotein
  • borderline resectable
  • conversion
  • intermediate stage
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