Efficacy of salvage surgery for hepatocellular carcinoma following conversion therapy.

Résumé

BACKGROUND: Salvage surgery following conversion therapy [transcatheter arterial chemoembolization (TACE) combined with tyrosine kinase inhibitors (TKIs) and anti-programmed cell death protein 1 (PD-1) antibodies] provides a chance for a cure in patients with unresectable hepatocellular carcinoma (uHCC).AIM: To primarily analyze the efficacy and safety of salvage surgery in patients initially diagnosed with uHCC who underwent conversion therapy.METHODS: We retrospectively collected data from patients at the First Affiliated Hospital of the University of Science and Technology of China (Anhui Provincial Hospital) who met the study criteria. These patients were initially diagnosed with uHCC and received TACE combined with TKIs and anti-PD-1 antibodies as conversion therapy. The main endpoints studied were the safety of salvage surgery, overall survival (OS), and recurrence-free survival (RFS) after surgery. Secondary endpoints included postoperative complications. We performed univariate and multivariate Cox regression analyses to identify independent risk factors for postoperative RFS.RESULTS: A total of 117 patients were enrolled in this study, including 28 patients (23.9%) who underwent curative surgery after triplet therapy conversion treatment. Among the 28 patients who underwent salvage surgery, the 1-year and 2-year RFS rates were 75.0% and 59.4%, respectively, and the 1-year and 2-year OS rates were 92.7% and 87.6%, respectively. The median follow-up time after surgery was 15.0 months (range: 1.6-37.2 months), with median OS and RFS not yet reached. Pathological complete response was achieved in 14 cases (50.0%), and postoperative complications occurred in 20 patients (71.4%). Univariate and multivariate Cox regression analyses indicated that pathological complete response and preoperative albumin levels were risk factors for postoperative RFS.CONCLUSION: Salvage surgery following conversion therapy with TACE combined with TKIs and anti-PD-1 antibodies appears to be an effective and safe treatment option for patients with uHCC. It extends OS and may offer additional potential benefits to uHCC patients.