Clinical Complete Response After Conversion Therapy for Unresectable Hepatocellular Carcinoma: Is Salvage Hepatectomy Necessary?

Jia-Yi Wu; Jun-Yi Wu; De-Yi Liu; Han Li; Shao-Wu Zhuang; Bin Li; Jian-Yin Zhou; Jing-Yao Huang; Zhi-Bo Zhang; Shu-Qun Li; Mao-Lin Yan; Yao-Dong Wang

doi:10.2147/JHC.S442341

Clinical Complete Response After Conversion Therapy for Unresectable Hepatocellular Carcinoma: Is Salvage Hepatectomy Necessary?

J Hepatocell Carcinoma. 2023 Dec 5:10:2161-2171. doi: 10.2147/JHC.S442341. eCollection 2023.

Authors

Jia-Yi Wu^#^{1

2}, Jun-Yi Wu^#^{1

2}, De-Yi Liu^#¹, Han Li^#¹, Shao-Wu Zhuang³, Bin Li⁴, Jian-Yin Zhou⁵, Jing-Yao Huang⁶, Zhi-Bo Zhang⁷, Shu-Qun Li⁸, Mao-Lin Yan^{1

2}, Yao-Dong Wang^{1

2}

Affiliations

¹ Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China.
² Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, People's Republic of China.
³ Department of Interventional Radiology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian Province, People's Republic of China.
⁴ Department of Hepato-Biliary-Pancreatic and Vascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, Fujian Province, People's Republic of China.
⁵ Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Xiamen, Fujian Province, People's Republic of China.
⁶ Department of Interventional Radiology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, People's Republic of China.
⁷ Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China.
⁸ Department of Hepatobiliary Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi Province, People's Republic of China.

^# Contributed equally.

Abstract

Background: This study aimed to determine whether salvage hepatectomy offers prognostic advantages for unresectable hepatocellular carcinoma (uHCC) patients with clinical complete response (cCR) after conversion therapy.

Methods: A total of 74 consecutive uHCC patients with cCR after conversion therapy at seven major cancer centers in China between October 2018 and December 2021 were included. One-to-one propensity score matching (PSM) was performed to minimize the influence of potential confounders. Disease-free survival (DFS) and overall survival (OS) rates were compared between the surgical group and the non-surgical group.

Results: Before PSM, 45 patients received salvage hepatectomy, and 29 patients received nonsurgical treatment. The 1-, 2-, and 3-year DFS rates were 77.8%, 61.5%, and 61.5% in the surgical group and 81.2%, 60.9%, and 60.9% in the non-surgical group, respectively. The 1-, 2-, and 3-year OS rates were 92.9%, 92.9%, and 69.7% in the surgical group and 100%, 70%, and 70% in the non-surgical group, respectively. There were no statistical differences in DFS and OS between groups [hazard ratio (HR)=0.715, 95% confidence interval (CI): 0.250-2.043, p=0.531; HR=0.980, 95% CI: 0.177-5.418, p=0.982, respectively]. After PSM, 26 pairs of patents were selected; there remained no significant differences in DFS and OS between these two groups (HR=1.547, 95% CI: 0.512-4.669, p=0.439; HR=1.024, 95% CI: 0.168-6.242, p=0.979, respectively).

Conclusion: Through the study, it tend to show that salvage hepatectomy may be not essential for uHCC patients with cCR, especially for patients with a high risk of surgical complications. Prospective trials with long term follow-up are warranted to evaluate this treatment option.

Keywords: conversion therapy; disease-free survival; hepatocellular carcinoma; overall survival; salvage surgery.

Grants and funding

This study was funded by the Natural Science Foundation of Fujian Province (Grant number: 2022J011021) and the Medical Innovation Project of Health and Family Planning Commission of Fujian Province (Grant number: 2022CXA002).