Lenvatinib and pembrolizumab plus FOLFOX-hepatic arterial infusion chemotherapy in locally advanced, potentially resectable hepatocellular carcinoma

Table 1 Criteria for defining successful conversion and surgical decision-making

Category	Criterion	Definition/threshold	Assessment method and timing
Overall requirement	MDT consensus	Agreement by hepatobiliary surgery, interventional radiology, and oncology	MDT review after every 2 cycles of therapy
Radiological response	Objective tumor response	Achieve complete or partial response according to RECIST 11 and/or modified RECIST	Contrast-enhanced CT/magnetic resonance imaging every 6 weeks; response must be confirmed on two consecutive scans ≥ 4 weeks apart
	Technical resectability	Tumor downstaging to allow for a potential R0 resection. Regression of major vascular involvement (e.g., portal vein tumor thrombus)	Volumetric and anatomical assessment via imaging
Liver function and volume	FLR volume	FLR > 40% of standardized total liver volume	CT volumetry prior to surgical decision
	Liver function reserve	Child-Pugh score ≤ 7	Laboratory and clinical evaluation every 3 weeks
		ICG 15-minute retention rate ≤ 20%	ICG clearance test prior to surgical decision
Patient general status	Performance status	Eastern Cooperative Oncology Group Performance Status score: 0-1	Clinical assessment every 3 weeks
Systemic disease control	Extrahepatic metastasis	Absence of new or progressive extrahepatic metastases	Chest CT and baseline extrahepatic imaging every 6 weeks
Surgical safety	Major organ function	No severe, uncontrolled comorbidities precluding major surgery (cardiopulmonary, renal insufficiency, etc.)	Comprehensive preoperative anesthesiology evaluation

CT: Computed tomography; FLR: Future liver remnant; ICG: Indocyanine green; MDT: Multidisciplinary team; RECIST: Response Evaluation Criteria in Solid Tumors.