Efficacy and safety of curative hepatectomy after conversion therapies for initial unresectable hepatocellular carcinoma: A multicenter propensity score matching study

Conversion therapy potentially converts the intermediate/advanced Barcelona Clinical Liver Cancer stage hepatocellular carcinoma (HCC) and unresectable HCC become resectable HCC. Patients have chronic liver injury caused by chronic liver diseases and conversion therapies and acute liver injury after hepatectomy. This study evaluated the efficacy and safety of curative resection for HCC after conversion therapy. 1220 HCC patients underwent initial curative resection and 142 patients received conversion therapies following curative resection were recruited from Guangxi Medical University Cancer Hospital and Eastern Hepatobiliary Surgery Hospital and divided into initial resected HCC (ir-HCC) group and converted resected (cr-HCC) group. Conversion strategies were detailed in the table. Covariate differences between the two groups were balanced by one-to-one propensity score matching (PSM). Overall survival (OS) and recurrence-free survival (RFS) were compared between the two groups. Risk factors of OS, RFS and severe post-hepatectomy liver failure (sPHLF) were determined.Table: 998PConversion therapeutic strategiesConversion therapyPatients (n = 142)TACE34TACE+Radiotherapy9HAIC3Radiotherapy1TKI+ICIs2HAIC+TKI1HAIC+TKI+ICIs6HAIC+TAE+TKI1HAIC+TAE+TKI+ICIs2HAIC+Radiotherapy+TKI+ICIs1TACE+TKI6TACE+ICIs5TACE+TKI+ICIs49TACE+Radiotherapy+TKI+ICIs8TACE+Radiotherapy+TKI2Radiotherapy+ICIs1Radiotherapy+TKI+ICIs12 Open table in a new tab 131 pairs were matched in ir-HCC group and ir-HCC group by PSM. The cr-HCC group had better mean RFS than ir-HCC group (16.2 vs. 12.7 months, P=0.011), but not mean OS (19.8 vs. 19.3 months, P=0.181). SPHLF rate was higher in cr-HCC group (34.4% vs. 19.1%, P=0.005). 90-day mortality showed no differences between the two groups (3.1% vs. 3.8%, P=0.734). Conversion therapy independently related to RFS and sPHLF, but not OS. Regional therapies increased the risk of sPHLF in cr-HCC group than ir-HCC group (P<0.05). There was no difference in sPHLF between regional therapy with and without systematic regimens in cr-HCC group. cr-HCC patients after curative resection had prolonged RFS but prone to sPHLF. Regional therapies was mainly responsible for sPHLF regardless combined systematic regimens.