Comparison of metastasectomy and stereotactic body radiation therapy for pulmonary oligometastasis from hepatocellular carcinoma: a propensity score-weighted analysis
Menée à partir de données 2008-2018 portant sur 209 patients atteints d'un carcinome hépatocellulaire et présentant des oligométastases pulmonaires (durée médiane de suivi : 39,8 mois), cette étude analyse l'efficacité, du point de vue de la survie, d'une ablation des métastases par rapport à une radiochirurgie
Résumé en anglais
Purpose: While there is a growing role for local therapy in patients with hepatocellular carcinoma (HCC) and pulmonary oligometastasis, it remains unclear whether metastatectomy or stereotactic body radiation therapy (SBRT) is the more effective treatment for these patients. We aimed to compare the oncologic outcomes of metastasectomy and SBRT for HCC with pulmonary oligometastasis.
Methods: We retrospectively analyzed 209 HCC patients with 322 metastatic lung lesions who underwent either metastasectomy (150 patients with 241 lesions) or SBRT (59 patients with 81 lesions) between January 2008 and December 2018. Propensity score-based inverse probability of treatment weighting (IPTW) was used to minimize potential bias between the two groups.
Results: The median follow-up duration was 39.8 months (range, 2.3–166.9). The 2-year rate of freedom from local progression (FFLP) was 98.2% in the metastasectomy group and 97.0% in the SBRT group (p = 0.197). The 2-year rates of overt systemic progression-free survival (ovPFS, 51.0% vs. 46.1%; p = 0.274), progression-free survival (PFS, 26.3% vs. 9.1%; p = 0.074), and overall survival (OS, 74.0% vs. 57.6%; p = 0.006) were higher in the metastasectomy group. After IPTW adjustment, the 2-year rates of ovPFS (50.8% vs. 52.7%; p = 0.396), PFS (23.0% vs. 24.7%; p = 0.478), and OS (72.6% vs. 83.0%, p = 0.428) were not significantly different between the two groups. In multivariate analysis, viable intrahepatic lesions and the number of prior liver-directed therapies were found to be significant prognostic factors for OS and PFS. The time interval between HCC diagnosis and the development of pulmonary metastases was also significantly associated with OS.
Conclusions: Both metastasectomy and SBRT demonstrated excellent local control and comparable oncologic outcomes in patients with pulmonary oligometastasis from HCC. The treatment modality for these patients could be determined based on the individual patient's condition and intrahepatic disease status.
