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Letter to the Editor
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Sep 15, 2025; 17(9): 106801
Published online Sep 15, 2025. doi: 10.4251/wjgo.v17.i9.106801
Postoperative immune checkpoint inhibitors plus anti-angiogenesis for hepatitis B virus-associated hepatocellular carcinoma: Analyzing the evidence and future prospects
Arunkumar Krishnan, Diptasree Mukherjee
Arunkumar Krishnan, Department of Supportive Oncology, Atrium Health Levine Cancer, Charlotte, NC 28204, United States
Diptasree Mukherjee, Department of Medicine, Apex Institute of Medical Science, Kolkata 700075, West Bengal, India
Author contributions: Krishnan A contributed to the concept of the study, drafted the manuscript, and participated in the review and editing; Krishnan A and Mukherjee D were involved with critically revising the manuscript for important intellectual content; they contributed equally to this article, and all authors reviewed and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Arunkumar Krishnan, MD, Department of Supportive Oncology, Atrium Health Levine Cancer, 1021 Morehead Medical Drive, Charlotte, NC 28204, United States. dr.arunkumar.krishnan@gmail.com
Received: March 7, 2025
Revised: April 9, 2025
Accepted: April 18, 2025
Published online: September 15, 2025
Processing time: 192 Days and 9.1 Hours
Abstract

A recent study by Lu et al examined the potential benefits of postoperative combined therapy (PCT) using anti-programmed cell death protein-1/PD-ligand-1 and anti-vascular endothelial growth factor agents for patients with hepatitis B virus-associated hepatocellular carcinoma (HBV-HCC). At the same time, the findings offer important insights; however, several methodological and statistical limitations should be noted. These limitations include selection bias from the study’s retrospective design, variability in treatment regimens, a small sample size, and inadequate monitoring of hepatitis B virus (HBV) reactivation. The study’s conclusions about PCT efficacy warrant cautious interpretation due to unresolved biases. Prospective trials with biomarker stratification are critical to confirm these preliminary findings. These findings underscore the need for prospective, biomarker-driven trials to validate the efficacy of PCT. Future research should prioritize standardized regimens, HBV reactivation monitoring, and global collaborations to optimize therapeutic strategies for HBV-HCC.

Keywords: Adverse events; Biomarkers; Bias; Confounders; Hepatitis B virus; Hepatocellular carcinoma; Postoperative combined therapy; Immunotherapy; Follow-up

Core Tip: A recent study by Lu et al examined postoperative combined therapy (PCT) for hepatitis B virus-associated hepatocellular carcinoma (HBV-HCC). While the findings provide important insights, it is essential to acknowledge several significant limitations. These include the potential for selection bias, a small sample size, and an insufficient focus on monitoring hepatitis B virus reactivation in detail. Future research should prioritize prospective, randomized controlled trials and adopt biomarker-driven approaches to advance the knowledge of the efficacy and safety of PCT. Moreover, extending follow-up periods and fostering global collaboration could enhance treatment outcomes and more effective patient care strategies in managing HBV-HCC.