Impact of Neoadjuvant Immunotherapy on Recurrence-Free Survival in Patients with High-Risk Localized HCC.

Autor:	Nakazawa M; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland., Fang M; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland., Vong T; Department of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland., Zorzi J; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland., Griffith P; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland., Anders RA; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland., Oshima K; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland., Kim AK; Department of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland., Laurin J; Department of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland., Lafaro KJ; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland., Shubert CR; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland., Burns WR; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland., He J; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland., Burkhart RA; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland., Philosophe B; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland., Meyer J; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland., Liddell RP; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.; Department of Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland., Georgiades C; Department of Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland., Hong K; Department of Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland., Ho WJ; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland., Baretti M; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland., Strauss AT; Department of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland., Yarchoan M; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Jazyk:	angličtina
Zdroj:	Cancer research communications [Cancer Res Commun] 2024 Aug 01; Vol. 4 (8), pp. 2123-2132.
DOI:	10.1158/2767-9764.CRC-24-0151
Abstrakt:	Surgical resection for localized hepatocellular carcinoma (HCC) is typically reserved for a minority of patients with favorable tumor features and anatomy. Neoadjuvant immunotherapy can expand the number of patients who are candidates for surgical resection and potentially reduce the chance for recurrence, but its role in HCC not defined. We retrospectively examined the outcomes of patients who underwent surgical resection for HCC at the Johns Hopkins Hospital and compared the clinical outcomes of patients who received neoadjuvant immunotherapy with those who underwent upfront resection. The clinical cohort included a total of 92 patients, 36 of whom received neoadjuvant immune checkpoint inhibitor (ICI)-based treatment. A majority of patients (61.1%) who received neoadjuvant ICI-based therapy were outside of standard resectability criteria and were more likely to have features known to confer risk of disease recurrence, including α-fetoprotein ≥ 400 ng/mL (P = 0.02), tumor diameter ≥ 5 cm (P = 0.001), portal vein invasion (P < 0.001), and multifocality (P < 0.001). Patients who received neoadjuvant immunotherapy had similar rates of margin-negative resection (P = 0.47) and recurrence-free survival (RFS) as those who underwent upfront surgical resection (median RFS 44.8 months compared with 49.3 months, respectively, log-rank P = 0.66). There was a nonsignificant trend toward superior RFS in the subset of patients with a pathologic response (tumor necrosis ≥ 70%) with neoadjuvant immunotherapy. Neoadjuvant ICI-based therapy may allow high-risk patients, including those who are outside traditional resectability criteria, to achieve comparable clinical outcomes with those who undergo upfront resection. Significance: Surgical resection for localized HCC is typically only reserved for those with solitary tumors without vascular invasion. In this retrospective analysis, we show that neoadjuvant immunotherapy may allow high-risk patients, including those who are outside of standard resection criteria, to undergo successful margin-negative resection and achieve comparable long-term clinical outcomes compared with upfront resection. These findings highlight need for prospective studies on neoadjuvant immunotherapy in HCC. (©2024 The Authors; Published by the American Association for Cancer Research.)
Databáze:	MEDLINE
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