Abstract：
OBJECTIVE: Sorafenib and lenvatinib have long been used as a first-line treatment for advanced hepatocellular carcinoma (HCC). Along with the development of systemic chemotherapy for HCC, the concept of conversion hepatectomy has recently become widespread. The present study aimed to assess the clinical outcomes of sorafenib and lenvatinib for HCC regarding the possibility of conversion hepatectomy in clinical practice.
METHODS: A total of 295 patients with advanced HCC receiving sorafenib and lenvatinib, accounting for 306 treatments (sorafenib, n=157; lenvatinib, n=149, 11 patients received lenvatinib after sorafenib treatment) at five different institutions were enrolled. Patients were assessed for their clinical characteristics and therapeutic response using both Response Evaluation Criteria in Solid Tumors criteria (RECIST) and modified RECIST (mRECIST) criteria. Additionally, an indication of surgery after tyrosine kinase inhibitor administration was determined based on the tumor status of patients.
RESULTS: The median survival times of patients treated with sorafenib and lenvatinib were 12.8 and 16.4 months, respectively, without significant difference (p=0.1645). The objective response rates (ORR) of sorafenib based on mRECIST and RECIST were 10.1% and 5.9%, respectively, and those of lenvatinib were 38.1% and 19.0%, respectively. Among the 306 treatments, two cases (sorafenib and lenvatinib, one each) underwent hepatectomy after systemic chemotherapy.
CONCLUSIONS: Few cases with unresectable HCC were amenable to conversion hepatectomy after sorafenib and lenvatinib treatments due to the limited ORR by RECIST. Cautious approach must be taken when administering neoadjuvant chemotherapy aimed at conversion hepatectomy.
METHODS: A total of 295 patients with advanced HCC receiving sorafenib and lenvatinib, accounting for 306 treatments (sorafenib, n=157; lenvatinib, n=149, 11 patients received lenvatinib after sorafenib treatment) at five different institutions were enrolled. Patients were assessed for their clinical characteristics and therapeutic response using both Response Evaluation Criteria in Solid Tumors criteria (RECIST) and modified RECIST (mRECIST) criteria. Additionally, an indication of surgery after tyrosine kinase inhibitor administration was determined based on the tumor status of patients.
RESULTS: The median survival times of patients treated with sorafenib and lenvatinib were 12.8 and 16.4 months, respectively, without significant difference (p=0.1645). The objective response rates (ORR) of sorafenib based on mRECIST and RECIST were 10.1% and 5.9%, respectively, and those of lenvatinib were 38.1% and 19.0%, respectively. Among the 306 treatments, two cases (sorafenib and lenvatinib, one each) underwent hepatectomy after systemic chemotherapy.
CONCLUSIONS: Few cases with unresectable HCC were amenable to conversion hepatectomy after sorafenib and lenvatinib treatments due to the limited ORR by RECIST. Cautious approach must be taken when administering neoadjuvant chemotherapy aimed at conversion hepatectomy.
摘要：
目的：索拉非尼和乐伐替尼长期以来被用作晚期肝细胞癌（HCC）的一线治疗。随着肝癌全身化疗的发展,转换肝切除术的概念最近变得普遍。本研究旨在评估索拉非尼和lenvatinib用于HCC的临床结果，关于临床实践中转换肝切除术的可能性。
方法：共295例晚期肝癌患者接受索拉非尼和乐伐替尼，占306种治疗方法(索拉非尼，n=157；来伐替尼，n=149，11例患者在5个不同的机构接受索拉非尼治疗后接受lenvatinib）。使用实体瘤标准（RECIST）中的反应评估标准和改良RECIST（mRECIST）标准评估患者的临床特征和治疗反应。此外,酪氨酸激酶抑制剂给药后的手术指征是根据患者的肿瘤状态确定的.
结果：索拉非尼和乐伐替尼治疗的患者的中位生存时间分别为12.8和16.4个月，分别,无显著性差异(p=0.1645)。基于mRECIST和RECIST的索拉非尼的客观缓解率（ORR）分别为10.1％和5.9％，分别,伦伐替尼的比例分别为38.1%和19.0%，分别。在306种治疗中，2例(索拉非尼和乐伐替尼，全身化疗后各行肝切除术。
结论：由于RECIST的ORR有限，在索拉非尼和lenvatinib治疗后，很少有不可切除的HCC患者可以进行肝切除术。在进行针对转换性肝切除术的新辅助化疗时，必须采取谨慎的方法。
方法：共295例晚期肝癌患者接受索拉非尼和乐伐替尼，占306种治疗方法(索拉非尼，n=157；来伐替尼，n=149，11例患者在5个不同的机构接受索拉非尼治疗后接受lenvatinib）。使用实体瘤标准（RECIST）中的反应评估标准和改良RECIST（mRECIST）标准评估患者的临床特征和治疗反应。此外,酪氨酸激酶抑制剂给药后的手术指征是根据患者的肿瘤状态确定的.
结果：索拉非尼和乐伐替尼治疗的患者的中位生存时间分别为12.8和16.4个月，分别,无显著性差异(p=0.1645)。基于mRECIST和RECIST的索拉非尼的客观缓解率（ORR）分别为10.1％和5.9％，分别,伦伐替尼的比例分别为38.1%和19.0%，分别。在306种治疗中，2例(索拉非尼和乐伐替尼，全身化疗后各行肝切除术。
结论：由于RECIST的ORR有限，在索拉非尼和lenvatinib治疗后，很少有不可切除的HCC患者可以进行肝切除术。在进行针对转换性肝切除术的新辅助化疗时，必须采取谨慎的方法。
