Outcomes for advanced hepatocellular carcinoma with pulmonary metastasis: Surgical vs. immunotherapy

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide, with over 70% of patients diagnosed at an advanced stage due to the absence of symptoms. A key characteristic of advanced HCC is extrahepatic metastasis, particularly pulmonary metastasis, which is associated with a poor prognosis.

Although multitargeted tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors have limited efficacy when used alone in advanced HCC, their combination can enhance outcomes for patients with pulmonary metastases. Meanwhile, pulmonary metastasectomy is still a key treatment for resectable lesions. Against this backdrop,  it is critical to define optimal management for patients with advanced hepatocellular carcinoma with pulmonary metastasis.

In a recent study published in the KeAi journal Liver Research, a multidisciplinary team of researchers across various institutions in China employed propensity score matching (PSM) to balance baseline characteristics and compared the efficacy of immunotherapy combined with targeted therapies to pulmonary metastasectomy in HCC patients with pulmonary metastasis (PM). The findings mainly revealed that surgical resection resulted in superior survival outcomes. Additionally, treatment allocation and hepatic tumor T stage were identified as independent prognostic factors for overall survival.

“Confounding variables in observational studies are often difficult to control completely; however, PSM balances confounding factors among comparison groups through matching technology which improves the accuracy and reliability of our research results,” says Jie Shi, lead author of the study. “For resectable PM, surgery provided better long-term prognosis, offering a vital option for the treatment of this subgroup of HCC patients.”

Successful control of hepatic tumors contributes to the prolongation of the overall survival of HCC patients with PM, indicating that local control of hepatic tumors is imperative whether undergoing pulmonary metastasectomy or systemic combination immunotherapy.

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Contact the author: Jie Shi, Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China. E-mail:docshijie@aliyun.com.

The publisher KeAi was established by Elsevier and China Science Publishing & Media Ltd to unfold quality research globally. In 2013, our focus shifted to open access publishing. We now proudly publish more than 200 world-class, open access, English language journals, spanning all scientific disciplines. Many of these are titles we publish in partnership with prestigious societies and academic institutions, such as the National Natural Science Foundation of China (NSFC).