Prognostic Value of Pathological Response After Conversion Therapy and Salvage Surgery in Unresectable Hepatocellular Carcinoma.

Résumé

BACKGROUND AND AIMS: To evaluate the prognostic significance of pathological response in patients with initially unresectable hepatocellular carcinoma (uHCC) who underwent salvage resection after successful conversion with lenvatinib, anti-PD-1 antibodies, and locoregional therapy (LPLRT).METHODS: This multicenter retrospective study included 102 uHCC patients who achieved curative resection after LPLRT across four tertiary centers in China. Residual viable tumour (pRVT) ratio was used to assess pathological response. Optimal pRVT cutoffs for overall survival (OS) and recurrence-free survival (RFS) were identified using X-tile (a statistical tool that identifies optimal prognostic cutoff values for continuous variables by systematically maximizing the log-rank statistic). Survival was analysed by Kaplan-Meier and log-rank tests, and prognostic factors by Cox regression analyses.RESULTS: Among 102 patients, 25 (24.5%) achieved pathological complete response (pCR). X-tile identified pRVT thresholds of 10% and 35% as optimal for predicting OS and RFS, respectively. Patients with pRVT ≤ 10% had superior OS (1-, 2-, 3 year: 96.6%, 89.8%, 82.5%) compared with pRVT > 10% (95.5%, 73.0%, 49.4%; p = 0.002). pRVT ≤ 35% was associated with longer RFS (1-, 2 year: 60.5%, 47.1% vs. 24.0%, 10.0%; p