Clinical Complete Response After Conversion Therapy for Unresectable Hepatocellular Carcinoma: Is Salvage Hepatectomy Necessary?

Figures & data

Table 1 Baseline Demographic Characteristics of Patients Who Achieved Clinical Complete Response

Characteristic	Cohort, No. (%)			p-value
	Total	Nonsurgical Treatment	Salvage Surgery
No.	74	29	45
Age, mean (SD), years	57.2 (11.5)	59.9 (11.1)	55.4 (11.5)	0.106
Sex
Female	10 (13.5)	5 (17.2)	5 (11.1)	0.451
Male	64 (86.5)	24 (82.8)	40 (88.9)
ECOG-PS
0	64 (86.5)	22 (75.9)	42 (93.3)	0.032
1	10 (13.5)	7 (24.1)	3 (6.7)
HBsAg
Positive	67 (90.5)	27 (93.1)	40 (88.9)	0.545
Negative	7 (9.5)	2 (6.9)	5 (11.1)
Pre-treatment PALBI grade
1 and 2	64 (86.5)	27 (93.1)	37 (82.2)	0.181
3	10 (13.5)	2 (6.9)	8 (17.8)
Pre-treatment ALT, U/L
<40	28 (37.8)	10 (34.5)	18 (40.0)	0.633
≥40	46 (62.2)	19 (65.5)	27 (60.0)
Pre-treatment AST, U/L
<40	30 (40.5)	11 (37.9)	19 (42.2)	0.714
≥40	44 (59.5)	18 (62.1)	26 (57.8)
Pre-treatment AFP, ng/mL
<400	38 (51.4)	15 (51.7)	23 (51.1)	0.959
≥400	36 (48.6)	14 (48.3)	22 (48.9)
Pre-treatment PIVKA-II, mAU/mL
<400	17 (23.0)	6 (20.7)	11 (24.4)	0.708
≥400	57 (77.0)	23 (79.3)	34 (75.6)
Tumor number
Solitary	32 (43.2)	11 (37.9)	21 (46.7)	0.459
Multiple	42 (56.8)	18 (62.1)	24 (53.3)
Maximum tumor size, cm
<10	40 (54.1)	17 (58.6)	23 (51.1)	0.527
≥10	34 (45.9)	12 (41.4)	22 (48.9)
BCLC stage
B	20 (27.0)	8 (27.6)	12 (26.7)	0.931
C	54 (73.0)	21 (72.4)	33 (73.3)
CNLC stage
IIa	5 (6.8)	2 (6.9)	3 (6.7)	0.996
IIb	15 (20.3)	6 (20.7)	9 (20.0)
IIIa	54 (73.0)	21 (72.4)	33 (73.3)
Main reason for conversion therapy
Bilobar tumor locations	18 (24.3)	8 (27.6)	10 (22.2)	0.857
Tumors could not be radically resected	46 (62.2)	17 (58.6)	29 (64.4)
Anticipated insufficient future liver remnant volume	10 (13.5)	4 (13.8)	6 (13.3)

Abbreviations: ECOG-PS, Eastern Cooperative Oncology Group performance status; HBsAg, hepatitis B surface antigen; PALBI, platelet-albumin-bilirubin grade; ALT, alanine aminotransferase; AST, aspartate aminotransferase; AFP, alpha-fetoprotein; PIVKA-II, protein induced by vitamin K absence or antagonist-II; BCLC, Barcelona Clinic Liver Cancer; CNLC, China Liver Cancer.

Figure 1 Flowchart of patient selection.

Abbreviations: uHCC, unresectable hepatocellular carcinoma; CR, complete response; ECOG-PS, Eastern Cooperative Oncology Group performance status; BCLC, Barcelona Clinic Liver Cancer; cCR, clinical complete response; TACE, transarterial chemoembolization; A+T, atezolizumab plus bevacizumab; PSM, propensity score matching.

Figure 2 Swimmer’s plot of the clinical course and current status of 17 progressing patients.

Abbreviations: cCR, clinical complete response; DFS, disease-free survival; LTP, Local tumor progression; IDR, intrahepatic distant recurrence; EDR, extrahepatic distant recurrence; HCC, hepatocellular carcinoma; PCR, pathologic complete response; MPR, major pathologic response.

Figure 3 Kaplan–Meier analysis of the DFS and OS before (A and B) and after PSM (C and D).

Abbreviations: DFS, disease-free survival; OS, overall survival; HR, hazard ratio; PSM, propensity score matching.