Efficacy of salvage surgery for hepatocellular carcinoma following conversion therapy

doi:10.5306/wjco.v16.i6.107255

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World Journal of Clinical Oncology

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World J Clin Oncol. Jun 24, 2025; 16(6): 107255
Published online Jun 24, 2025. doi: 10.5306/wjco.v16.i6.107255

Efficacy of salvage surgery for hepatocellular carcinoma following conversion therapy

Shao-Bo Zhang, Bjorn Nashan, Yan-Li Wang, Shu-Geng Zhang

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.

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 16.2 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.

Keywords: Hepatocellular carcinoma; Salvage surgery; Systemic therapy; Conversion therapy; Transcatheter arterial chemoembolization

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.