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Outcomes of Salvage Surgery Versus Non-Salvage Surgery for Initially Unresectable Hepatocellular Carcinoma After Conversion Therapy with Transcatheter Arterial Chemoembolization Combined with Lenvatinib Plus Anti-PD-1 Antibody: A Multicenter Retrospective Study

  • Hepatobiliary Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Combination treatment with transcatheter arterial chemoembolization (TACE), lenvatinib, and anti-programmed death-1 (anti-PD-1) antibodies (triple therapy) has a high rate of tumor response and converted resection for initially unresectable hepatocellular carcinoma (uHCC) patients. This study aimed to assess the outcomes of salvage surgery in uHCC patients after conversion therapy with triple therapy.

Methods

uHCC patients who met the criteria for hepatectomy after receiving triple therapy as first-line treatment were eligible for inclusion in this study. The overall survival (OS) and progression-free survival (PFS) rates in patients who received salvage surgery (SR group) and those who did not (non-SR group) were compared.

Results

Of the 144 patients assessed, 91 patients underwent salvage surgery and 53 did not. The OS rates in the SR group were significantly better than those in the non-SR group. The 1- and 2-year OS rates in the SR group were 92.0% and 79.9%, respectively, whereas those in the non-SR group were 85.5% and 39.6 %, respectively (p = 0.007); however, there was no significant difference in the PFS rates. Upon further stratification, OS and PFS were significantly better in the SR group than in the non-SR group in patients who were assessed as partial responses (PR), while there was no significant difference in patients who were assessed as complete response (CR).

Conclusions

Salvage surgery is recommended and is associated with a favorable prognosis for uHCC patients who were assessed as PR after conversion therapy, however it may not be necessary for uHCC if CR was achieved.

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Acknowledgment

This research was sponsored by the key Clinical Specialty Discipline Construction Program of Fujian, People’s Republic of China. The authors wish to thank all the staff of the participating hospitals for their kind cooperation and support, as well as all patients for their participation.

Funding

This research was supported by the Medical Innovation Project of Fujian Province (Grant Number: 2022CXA002), the Natural Science Foundation of Fujian Province, China (Grant Number: 2020J011105, 2022J011021), and the Startup Fund for Scientific Research, Fujian Medical University (Grant Number: 2018QH1112).

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Author notes

  1. Jun-Yi Wu, Jia-Yi Wu, and Yang-Kai Fu have contributed equally to this work.

Authors and Affiliations

  1. Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China

    Jun-Yi Wu MD, PhD, Jia-Yi Wu MD, Yang-Kai Fu MD, Xiang-Ye Ou MD & Mao-Lin Yan MD, PhD

  2. Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, China

    Jun-Yi Wu MD, PhD, Jia-Yi Wu MD, Yang-Kai Fu MD, Xiang-Ye Ou MD & Mao-Lin Yan MD, PhD

  3. Department of Hepatobiliary Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi Province, China

    Shu-Qun Li MD

  4. Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China

    Zhi-Bo Zhang MD

  5. Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Xiamen, Fujian Province, China

    Jian-Yin Zhou MD

  6. Department of Hepato-Biliary-Pancreatic and Vascular Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian Province, China

    Bin Li MD & Shuang-Jia Wang MD

  7. Department of Hepatobiliary Surgery, The Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian Province, China

    Yu-Feng Chen MD

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Correspondence to Mao-Lin Yan MD, PhD.

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Jun-Yi Wu, Jia-Yi Wu, Yang-Kai Fu, Xiang-Ye Ou, Shu-Qun Li, Zhi-Bo Zhang, Jian-Yin Zhou, Bin Li, Shuang-Jia Wang, Yu-Feng Chen, and Mao-Lin Yan have no related conflicts of interest to declare.

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Wu, JY., Wu, JY., Fu, YK. et al. Outcomes of Salvage Surgery Versus Non-Salvage Surgery for Initially Unresectable Hepatocellular Carcinoma After Conversion Therapy with Transcatheter Arterial Chemoembolization Combined with Lenvatinib Plus Anti-PD-1 Antibody: A Multicenter Retrospective Study. Ann Surg Oncol 31, 3073–3083 (2024). https://doi.org/10.1245/s10434-024-14944-3

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