Zhang SB, Nashan B, Wang YL, Zhang SG. Efficacy of salvage surgery for hepatocellular carcinoma following conversion therapy. World J Clin Oncol 2025; 16(6): 107255 [DOI: 10.5306/wjco.v16.i6.107255]
Corresponding Author of This Article
Shu-Geng Zhang, Department of Liver Transplantation, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Science and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Luyang District, Hefei 230001, Anhui Province, China. zsg0517@ustc.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Shao-Bo Zhang, Bjorn Nashan, Shu-Geng Zhang, Department of Liver Transplantation, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Science and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
Shao-Bo Zhang, Yan-Li Wang, Shu-Geng Zhang, Graduate School of Bengbu Medical University, Bengbu Medical University, Bengbu 233000, Anhui Province, China
Author contributions: Zhang SB and Zhang SG contributed to the conception and design of the study; Zhang SB and Wang YL contributed to acquisition of data; Zhang SB contributed to data analysis, administration or material support, drafted manuscript, and interpretation; Zhang SG verified the data; Nashan B and Zhang SG contributed to review and/or revision of the manuscript; and all authors have read and approved the final manuscript to be published.
Supported by the Anhui Provincial Department of Education, No. 2022AH020077.
Institutional review board statement: This study was approved by the Medical Ethics Committee of First Affiliated Hospital of the University of Science and Technology of China, Anhui Provincial Hospital, approval No. 2024-RE-186.
Informed consent statement: This is a retrospective study that confirms that the privacy and personal information of the patients involved is confidential and, therefore, informed consent is not required for this study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets generated and analyzed during the present study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shu-Geng Zhang, Department of Liver Transplantation, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Science and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Luyang District, Hefei 230001, Anhui Province, China. zsg0517@ustc.edu.cn
Received: March 19, 2025 Revised: April 15, 2025 Accepted: May 7, 2025 Published online: June 24, 2025 Processing time: 93 Days and 10 Hours
Abstract
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.
Core Tip: For patients with advanced hepatocellular carcinoma, the opportunity for radical surgical treatment is lost. Patients who receive targeted drugs, immune drugs, or localized regional therapies cannot achieve a complete cure in the clinical sense, although it may lead to remission of the tumor lesions and improve overall survival. Patients after receiving transcatheter arterial chemoembolization combined with targeted and immune drugs, the liver cancer lesions were in remission, which was in line with the indication range of surgical resection. Postoperative complications in patients treated with salvage surgery were within acceptable limits and overall survival was prolonged.
