Hepatic Arterial Infusion Chemotherapy as a Timing Strategy for Conversion Surgery to Treat Hepatocellular Carcinoma: A Single-Center Real-World Study

Jiongliang Wang; Zhikai Zheng; Tianqing Wu; Wenxuan Li; Juncheng Wang; Yangxun Pan; Wei Peng; Dandan Hu; Jiajie Hou; Li Xu; Yaojun Zhang; Minshan Chen; Rongxin Zhang; Zhongguo Zhou

doi:10.2147/JHC.S379326

Hepatic Arterial Infusion Chemotherapy as a Timing Strategy for Conversion Surgery to Treat Hepatocellular Carcinoma: A Single-Center Real-World Study

J Hepatocell Carcinoma. 2022 Sep 14:9:999-1010. doi: 10.2147/JHC.S379326. eCollection 2022.

Authors

Jiongliang Wang^#^{1

2}, Zhikai Zheng^#^{1

2}, Tianqing Wu^#^{1

2}, Wenxuan Li^#^{1

2}, Juncheng Wang^{1

2}, Yangxun Pan^{1

2}, Wei Peng^{1

2}, Dandan Hu^{1

2}, Jiajie Hou^{1

2}, Li Xu^{1

2}, Yaojun Zhang^{1

2}, Minshan Chen^{1

2}, Rongxin Zhang^{2

3}, Zhongguo Zhou^{1

2}

Affiliations

¹ Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
² Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.
³ Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.

^# Contributed equally.

Abstract

Objective: To evaluate whether surgery-related complications are increased after hepatic arterial infusion chemotherapy (HAIC) using oxaliplatin plus fluorouracil/leucovorin for conversion compared with primary hepatocellular carcinoma (HCC) resection and the optimal timing of conversion surgery (CS).

Background: HAIC has been widely used for advanced HCC, especially initially unresectable HCC, to facilitate conversion to curative-intent resection in approximately 23.8% of cases. However, the optimal timing of surgery to reduce surgical complications must be clarified.

Methods: Data from 320 HCC patients, including 107 initially unresectable patients in the HAIC-Surgery group and 213 patients in the Surgery group, were retrospectively collected and analyzed. Survival outcomes and the incidence of surgery-related complications were compared.

Results: There was no significant difference in recurrence-free survival (RFS) between the HAIC-Surgery group and the Surgery group (HR: 1.140, 95% CI: 0.8027-1.618, p=0.444). The HAIC-Surgery group had a higher incidence of surgery-related complications than the Surgery group [biliary leakage (10.3% vs 4.2%, p=0.035), abdominal bleeding (10.3% vs 3.8%, p=0.020), pleural effusion (56.1% vs 23.0%, p<0.0001) and ascites effusion (17.8% vs 5.2%, p<0.0001)]. In the HAIC-Surgery group, postoperative liver function decreased and abdominal bleeding increased with more preoperative HAIC cycles (Spearman=0.229, p=0.042, Spearman=0.198, p=0.041, respectively). The pathological complete remission (pCR) rate after 3-5 HAIC cycles was significantly higher than that after 1-2 cycles (29.4% vs 13.2%, p=0.043).

Conclusion: The prognosis of advanced HCC after conversion surgery is comparable to that after direct surgery. Rather than increasing pCR, more HAIC cycles can exacerbate liver dysfunction and surgery-related complications.

Keywords: conversion therapy; hepatic artery chemotherapy infusion; hepatocellular carcinoma.

Grants and funding

This work is funded by Sun Yat-sen University Cancer Center physician scientist funding (No. 16zxqk04), Wu Jieping Medical Foundation - special fund for tumor immunity (320.6705.2021-02-76).