Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2022; 28(26): 3232-3242
Published online Jul 14, 2022. doi: 10.3748/wjg.v28.i26.3232
Tumor-feeding artery diameter reduction is associated with improved short-term effect of hepatic arterial infusion chemotherapy plus lenvatinib treatment
De-Di Wu, Xiao-Feng He, Chen Tian, Peng Peng, Chuan-Li Chen, Xue-Han Liu, Hua-Jin Pang
De-Di Wu, Xiao-Feng He, Chen Tian, Peng Peng, Hua-Jin Pang, Division of Vascular and Interventional Radiology, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Chuan-Li Chen, Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Xue-Han Liu, Department of Statistics, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
Author contributions: Wu DD and Pang HJ designed this study; Wu DD, Tian C, and Chen CL performed the reconstruction and measurement; Wu DD, Liu XH, and Pang HJ analyzed the data; Peng P collected the clinical data; Wu DD wrote the paper; He XF and Pang HJ made critical revisions to the paper; all authors approved the publication of the paper.
Institutional review board statement: The research was conducted in accordance with the 1975 Declaration of Helsinki and approved by the medical ethics committee of Nanfang Hospital, Southern Medical University.
Informed consent statement: The requirement for informed consent was waived owing to the retrospective nature of the study.
Conflict-of-interest statement: There was no conflict of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hua-Jin Pang, PhD, Associate Chief Physician, Associate Professor, Division of Vascular and Interventional Radiology, Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838 North Baiyun Avenue, Guangzhou 510515, Guangdong Province, China. nfyyphj@163.com
Received: January 22, 2022
Peer-review started: January 22, 2022
First decision: March 8, 2022
Revised: March 17, 2022
Accepted: June 18, 2022
Article in press: June 18, 2022
Published online: July 14, 2022
Processing time: 172 Days and 2.9 Hours
Abstract
BACKGROUND

Recently, hepatic arterial infusion chemotherapy (HAIC) plus lenvatinib has been frequently used to treat unresectable hepatocellular carcinoma (uHCC) in China. In the clinic, the hepatic arteries of some patients shrink significantly during this treatment, leading to improved short-term efficacy.

AIM

To investigate the relationship between the shrinkage of hepatic arteries and the short-term effect of HAIC plus lenvatinib treatment.

METHODS

Sixty-seven participants with uHCC were enrolled in this retrospective study. The patients received HAIC every 3 wk, followed by oral lenvatinib after the first HAIC course. Hepatic artery diameters were measured on CT before treatment and after 1 and 2 mo of treatment. Meanwhile, the changes in tumor capillaries were also examined on pathological specimens before and after 1 mo of treatment. The antitumor response after 1, 3, and 6 mo of treatment was assessed using the modified Response Evaluation Criteria in Solid Tumors (mRECIST). The relationship between the changes in vessel diameters and the short-term effect of the combination treatment was evaluated by receiver-operating characteristic and logistic regression analyses.

RESULTS

The hepatic artery diameters were all significantly decreased after 1 and 2 mo of treatment (P < 0.001), but there was no difference in the vessel diameters between 1 and 2 mo (P > 0.05). The microvessel density in the tumor lesions decreased significantly after 1 mo of combination treatment (P < 0.001). According to mRECIST, 46, 41, and 24 patients had complete or partial responses after 1, 3, and 6 mo of treatment, respectively, whereas 21, 21, and 32 patients had a stable or progressive disease at these times, respectively. Shrinkage of the tumor-feeding artery was significantly associated with the tumor response after 1, 3, and 6 mo of treatment (P < 0.001, P = 0.004, and P = 0.023, respectively); however, changes in other hepatic arteries were not significantly associated with the tumor response. Furthermore, shrinkage of the tumor-feeding artery was an independent factor for treatment efficacy (P = 0.001, P = 0.001, and P = 0.002 and 1, 3, and 6 mo, respectively).

CONCLUSION

The hepatic arteries shrank rapidly after treatment with HAIC plus lenvatinib, and shrinkage of the tumor-feeding artery diameter was closely related to improved short-term efficacy.

Keywords: Hepatocellular carcinoma, Hepatic arterial infusion chemotherapy, Lenvatinib, Short-term effect, Hepatic artery, Vessel diameter

Core Tip: In this study, it was observed for the first time that the hepatic arteries shrank rapidly after hepatic arterial infusion chemotherapy plus lenvatinib therapy, and the close relationship between shrinkage of the tumor-feeding artery and improved short-term effect in patients with unresectable hepatocellular carcinoma was also confirmed. These findings would be of great significance to physicians for evaluating the effectiveness of this combination therapy earlier in the course of treatment and altering the treatment plan as needed.