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

Abstract

Jia-Yi Wu,1,2,* Jun-Yi Wu,1,2,* De-Yi Liu,1,* Han Li,1,* Shao-Wu Zhuang,3 Bin Li,4 Jian-Yin Zhou,5 Jing-Yao Huang,6 Zhi-Bo Zhang,7 Shu-Qun Li,8 Mao-Lin Yan,1,2 Yao-Dong Wang1,2 1Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, People’s Republic of China; 2Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, People’s Republic of China; 3Department of Interventional Radiology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian Province, People’s Republic of China; 4Department of Hepato-Biliary-Pancreatic and Vascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, Fujian Province, People’s Republic of China; 5Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Xiamen, Fujian Province, People’s Republic of China; 6Department of Interventional Radiology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, People’s Republic of China; 7Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, People’s Republic of China; 8Department of Hepatobiliary Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Mao-Lin Yan; Yao-Dong Wang, The Shengli Clinical Medical College of Fujian Medical University, Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Dongjie Road 134, Fuzhou, Fujian Province, 350001, People’s Republic of China, Tel [phone], Fax [phone], Email [email protected]; [email protected]: 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.Plain Language Summary: To date, there is limited evidence on the prognosis of the unresectable hepatocellular carcinoma (uHCC) patients with clinical complete response (cCR), and the necessity of salvage surgery remains controversial. In this study, they compare and evaluate therapeutic benefits of salvage hepatectomy and nonsurgical treatment in the management of uHCC patients with cCR after conversion therapy. Finally, a total of 74 consecutive uHCC patients with cCR after conversion therapy at seven major cancer centers in China were included. There were no statistically significant differences for disease-free survival and overall survival were observed before and after propensity score matching. They revealed that cCR after conversion therapy led to a good prognosis for patients with uHCC. Furthermore, nonsurgical treatment provided similar survival benefits to those of salvage hepatectomy, suggesting that salvage hepatectomy may be not essential for uHCC patients with cCR.Keywords: conversion therapy, hepatocellular carcinoma, overall survival, disease-free survival, salvage surgery

Keywords

• conversion therapy
• hepatocellular carcinoma
• overall survival
• recurrence-free survival
• salvage surgery