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Purpose <p>There is no standard treatment for hepatocellular carcinoma (HCC) with macrovascular invasion (MaVI). This study aimed to evaluate the effectiveness of liver resection (LR) and the timing of systemic therapy in HCC with MaVI.</p> Methods <p>The SEER database included 106,613 HCC patients, 1,892 of whom had MaVI. Patients were divided into the LR group (<i>n</i> = 126) and Non-LR group (<i>n</i> = 1,766). The LR group was further split into those receiving preoperative systemic treatment (pre-AST, <i>n</i> = 32) and postoperative systemic treatment (post-AST, <i>n</i> = 37). Overall survival (OS) was compared using Kaplan–Meier survival curves. Cox regression analysis identified independent risk factors, and propensity score matching (PSM) was used to reduce selection bias.</p> Results <p>Liver resection was performed in 12.8% of cases, including 9.4% of stage III and 2.2% of stage IV patients. After PSM, the 1-, 3-, and 5-year OS rates in the LR group were 65.9%, 37.7%, and 28.6%, respectively, compared to 29.3%, 10.1%, and 5.4% in the Non-LR group (<i>p</i> &lt; 0.01). Multivariate Cox analysis identified LR as an independent factor for improved OS (HR = 0.36, 95%CI = 0.25–0.50, <i>p</i> &lt; 0.01). In the pre-AST and post-AST groups, the 1-, 3-, and 5-year OS rates were 81.2%, 50.0%, 40.6% and 45.9%, 21.6%, 13.5%, respectively (<i>p</i> = 0.01).</p> Conclusions <p>Liver resection is linked to better survival outcomes for HCC patients with macrovascular invasion, especially when preoperative systemic treatment is given.</p>

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Systemic therapy followed by liver resection improved prognosis of hepatocellular carcinoma associated with macrovascular invasion

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月25日

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  • Jinyu Zhang,
  • Zirui Zhang,
  • Qionglan Wu,
  • Jinhua Zeng,
  • Jingfeng Liu,
  • Jianxing Zeng

摘要

Purpose

There is no standard treatment for hepatocellular carcinoma (HCC) with macrovascular invasion (MaVI). This study aimed to evaluate the effectiveness of liver resection (LR) and the timing of systemic therapy in HCC with MaVI.

Methods

The SEER database included 106,613 HCC patients, 1,892 of whom had MaVI. Patients were divided into the LR group (n = 126) and Non-LR group (n = 1,766). The LR group was further split into those receiving preoperative systemic treatment (pre-AST, n = 32) and postoperative systemic treatment (post-AST, n = 37). Overall survival (OS) was compared using Kaplan–Meier survival curves. Cox regression analysis identified independent risk factors, and propensity score matching (PSM) was used to reduce selection bias.

Results

Liver resection was performed in 12.8% of cases, including 9.4% of stage III and 2.2% of stage IV patients. After PSM, the 1-, 3-, and 5-year OS rates in the LR group were 65.9%, 37.7%, and 28.6%, respectively, compared to 29.3%, 10.1%, and 5.4% in the Non-LR group (p < 0.01). Multivariate Cox analysis identified LR as an independent factor for improved OS (HR = 0.36, 95%CI = 0.25–0.50, p < 0.01). In the pre-AST and post-AST groups, the 1-, 3-, and 5-year OS rates were 81.2%, 50.0%, 40.6% and 45.9%, 21.6%, 13.5%, respectively (p = 0.01).

Conclusions

Liver resection is linked to better survival outcomes for HCC patients with macrovascular invasion, especially when preoperative systemic treatment is given.