Efficacy and safety of lenvatinib as adjuvant therapy for hepatocellular carcinoma with vascular invasion after curative resection.

[BACKGROUND] Although several postoperative adjuvant therapies for hepatocellular carcinoma (HCC) have shown efficacy in reducing recurrence, no globally accepted guidelines exist for patients with vascular invasion after curative resection. This study aimed to evaluate the efficacy and safety of lenvatinib (Len) as adjuvant therapy for patients with HCC with vascular invasion after curative liver resection (LR).

[METHODS] Patients with HCC with vascular invasion, including microvascular invasion (MVI) and portal vein tumor thrombus (PVTT), who underwent curative resection at 2 hospitals were retrospectively reviewed. Overall survival (OS), recurrence-free survival (RFS), and recurrence patterns were compared between patients treated with LR alone and those receiving postoperative Len (LR + Len) using propensity score matching (PSM).

[RESULTS] A total of 326 patients with HCC with vascular invasion were enrolled. Among them, 248 (76.1%) had MVI; 79 patients were allocated to the LR + Len group, and the others to the LR group. After PSM (1:3), 73 patients were included in the LR + Len group and 172 patients in the LR group. In the matched cohort, patients in the LR + Len group had significantly longer RFS (hazard ratio [HR], 1.54; 95% CI, 1.03-2.29; P =.032) and OS (HR, 2.11; 95% CI, 1.08-4.10; P =.025) than those undergoing LR alone. Subgroup analysis revealed that adjuvant Len significantly improved both RFS and OS in patients with MVI, but it conferred no benefit to those with PVTT.

[CONCLUSION] Postoperative adjuvant Len therapy was associated with longer OS and RFS for patients with HCC with vascular invasion, particularly for those with MVI.