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Background <p>No consensus exists on optimal post-conversion therapy for initially unresectable hepatocellular carcinoma (uHCC) patients responding to a combination of immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs). This study evaluated surgical benefits and prognostic factors in such patients.</p> Methods <p>Retrospective analysis of 67 uHCC patients receiving ICIs + TKIs conversion therapy. Log-rank test compared OS/PFS between surgical resection (SR, <i>n</i> = 30) and non-surgical (NSR, <i>n</i> = 37) groups; Cox regression identified prognostic factors.</p> Results <p>Baseline variables were balanced between groups. The SR group showed significantly higher PFS than the NSR group (<i>P</i> = 0.032), with 1-, 2-, and 3-year rates of 82.6%, 53.5%, and 31.2% versus 71.1%, 21.6%, and 14.4% for the NSR group. Partial response (PR) (HR = 6.0, <i>P</i> &lt; 0.001) and AFP level ≥ 400 ng/ml (HR = 2.8, <i>P</i> = 0.021) emerged as independent prognostic factors associated with OS. For PFS, partial response (PR) (HR = 3.3, <i>P </i>= 0.002), number of tumors ≥ 3 (HR = 2.4, <i>P</i> = 0.020), and non-surgical treatment (HR = 2.2, <i>P</i> = 0.031) were relevant.</p> Conclusion <p>Surgical intervention resulted in better PFS than non-surgical approaches, while no significant difference in OS was observed.</p>

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Prognostic outcomes of surgery vs. non-surgery in initially unresectable HCC with successful conversion via ICI + TKI therapy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月13日

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  • Zengpeng Sun,
  • Yutao Wang,
  • Zhiguo Tan,
  • Jia Zhou,
  • Xu Chen,
  • Ou Li,
  • Chuang Peng

摘要

Background

No consensus exists on optimal post-conversion therapy for initially unresectable hepatocellular carcinoma (uHCC) patients responding to a combination of immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs). This study evaluated surgical benefits and prognostic factors in such patients.

Methods

Retrospective analysis of 67 uHCC patients receiving ICIs + TKIs conversion therapy. Log-rank test compared OS/PFS between surgical resection (SR, n = 30) and non-surgical (NSR, n = 37) groups; Cox regression identified prognostic factors.

Results

Baseline variables were balanced between groups. The SR group showed significantly higher PFS than the NSR group (P = 0.032), with 1-, 2-, and 3-year rates of 82.6%, 53.5%, and 31.2% versus 71.1%, 21.6%, and 14.4% for the NSR group. Partial response (PR) (HR = 6.0, P < 0.001) and AFP level ≥ 400 ng/ml (HR = 2.8, P = 0.021) emerged as independent prognostic factors associated with OS. For PFS, partial response (PR) (HR = 3.3, P = 0.002), number of tumors ≥ 3 (HR = 2.4, P = 0.020), and non-surgical treatment (HR = 2.2, P = 0.031) were relevant.

Conclusion

Surgical intervention resulted in better PFS than non-surgical approaches, while no significant difference in OS was observed.