Optimal duration of adjuvant targeted-immunotherapy in patients with initially unresectable hepatocellular carcinoma with portal vein tumor thrombus following successful conversion therapy.

Résumé

BACKGROUND: The management of initially unresectable hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) has been revolutionized by conversion therapy combining locoregional and systemic modalities. While successful downstaging followed by salvage surgery offers potential for cure, the optimal duration of postoperative adjuvant targeted-immunotherapy remains poorly defined. This multicenter study aimed to determine the relationship between adjuvant therapy duration and survival outcomes in this specific patient population.METHODS: We conducted a retrospective cohort analysis of 124 patients with initially unresectable HCC and PVTT who achieved successful conversion using combined local-systemic therapy and subsequently underwent R0 resection at 4 tertiary medical centers between September 2019 and December 2022. Patients were stratified into 4 groups according to adjuvant targeted-immunotherapy duration: no adjuvant therapy (0 month, n = 26), short-term therapy (1-3 months, n = 28), medium-term therapy (4-6 months, n = 25), and extended therapy (≥7 months, n = 45). Primary endpoints were overall survival (OS) and progression-free survival (PFS), analyzed using Kaplan-Meier methods and Cox proportional hazards models.RESULTS: With a median follow-up of 28.3 months, significant differences in both OS and PFS were observed among the 4 groups (both P