Conversion Therapy Based on TACE/HAIC-Based Treatment to Improve the Therapeutic Effect of Initially Unresectable Hepatocellular Carcinoma.

Résumé

OBJECTIVES: The main objectives of this research are to evaluate the outcomes of patients with initially unresectable hepatocellular carcinoma (HCC) who received transcatheter arterial chemoembolization (TACE)/hepatic artery infusion chemotherapy (HAIC)-based combination therapy and to investigate the effects of liver resection following comprehensive conversion therapy on the short-term benefits and long-term survival of these patients.MATERIALS AND METHODS: A total of 301 initially unresectable HCC patients who received TACE/HAIC-based combination therapy between January 2019 and December 2021 were retrospectively reviewed. The study analyzed the conversion rate to resection, changes in tumor burden after treatment, and the survival outcomes.RESULTS: The study found that 20.9% (63/301) of initially unresectable HCC patients were able to undergo liver resection. The conversion resection rate among all patients was 38.2% (29/76) and 17.3% (23/132) for those with Barcelona Clinic Liver Cancer (BCLC) stage A and C. Patients who underwent surgery achieved promising outcomes with a pathological complete response (pCR) rate of 31.7% (20/63) and a 100% R0 resection rate. Kaplan-Meier survival analysis showed that patients who had successful surgery after conversion therapy had significantly longer median overall survival (OS) (not reached vs. 58.5 months) and progression-free survival (PFS) (42.83 months vs. 9.7 months) compared to those who did not (both < 0.05). Additionally, patients achieving radiographic complete response (CR) had significantly better OS and PFS than those who did not. Multivariable logistic regression analysis showed that age (OR = 0.95, < 0.001), positive HBsAg expression (OR = 0.34, = 0.011), and alpha-fetoprotein levels ≥400 (OR = 0.49, = 0.045), ECOG PS score of 1 (OR = 0.43, = 0.038), BCLC stage B (OR = 0.23, < 0.001) and stage C (OR = 0.44, = 0.045), systemic inflammation response index (OR = 0.73, = 0.018) were independent predictors for successful conversion surgery (all < 0.05).CONCLUSION: Patients with initially unresectable HCC can achieve promising curative effects and conversion resection rates with TACE/HAIC-based comprehensive therapy. More importantly, patients who undergo liver resection following conversion resection had significantly better long-term survival.