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

References

• Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. doi:10.3322/caac.21492
   PubMed Web of Science ®Google Scholar
• Reig M, Forner A, Rimola J, et al. BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update. J Hepatol. 2022;76(3):681–693. doi:10.1016/j.jhep.2021.11.018
   PubMed Web of Science ®Google Scholar
• Zhou J, Sun H, Wang Z, et al. Guidelines for the diagnosis and treatment of Hepatocellular carcinoma (2019 edition). Liver Cancer. 2020;9(6):682–720. doi:10.1159/000509424
   PubMed Web of Science ®Google Scholar
• Roayaie S, Jibara G, Tabrizian P, et al. The role of hepatic resection in the treatment of hepatocellular cancer. Hepatology. 2015;62(2):440–451. doi:10.1002/hep.27745
   PubMed Web of Science ®Google Scholar
• European Association for the Study of the Liver. EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182–236. doi:10.1016/j.jhep.2018.03.019
   PubMed Web of Science ®Google Scholar
• Bruix J, Gores G, Mazzaferro V. Hepatocellular carcinoma: clinical frontiers and perspectives. Gut. 2014;63(5):844–855. doi:10.1136/gutjnl-2013-306627
   PubMed Web of Science ®Google Scholar
• Villanueva A, Longo DL. Hepatocellular carcinoma. N Engl J Med. 2019;380(15):1450–1462. doi:10.1056/NEJMra1713263
   PubMed Web of Science ®Google Scholar
• Sun H, Zhou J, Wang Z, et al. Chinese expert consensus on conversion therapy for hepatocellular carcinoma (2021 edition). Hepatobiliary Surg Nutr. 2022;11(2):227–252. doi:10.21037/hbsn-21-328
   PubMed Web of Science ®Google Scholar
• Kudo M. Combination cancer immunotherapy in hepatocellular carcinoma. Liver Cancer. 2018;7(1):20–27. doi:10.1159/000486487
   PubMed Web of Science ®Google Scholar
• Luo X, Wu K, He X. Advances in drug development for hepatocellular carcinoma: clinical trials and potential therapeutic targets. J Exp Clin Cancer Res. 2021;40(1):172. doi:10.1186/s13046-021-01968-w
   PubMed Web of Science ®Google Scholar
• Wu J, Yin Z, Bai Y, et al. Lenvatinib combined with anti-PD-1 antibodies plus transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma: a multicenter retrospective study. J Hepatocell Carcinoma. 2021;8:1233–1240. doi:10.2147/JHC.S332420
   PubMed Web of Science ®Google Scholar
• Zhu X, Huang C, Shen Y, et al. Downstaging and resection of initially unresectable hepatocellular carcinoma with tyrosine kinase inhibitor and anti-PD-1 antibody combinations. Liver Cancer. 2021;10(4):320–329. doi:10.1159/000514313
   PubMed Web of Science ®Google Scholar
• Zhu X, Huang C, Shen Y, et al. Hepatectomy after conversion therapy using tyrosine kinase inhibitors plus anti-PD-1 antibody therapy for patients with unresectable hepatocellular carcinoma. Ann Surg Oncol. 2023;30(5):2782–2790. doi:10.1245/s10434-022-12530-z
   PubMed Web of Science ®Google Scholar
• Lencioni R, Llovet J. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis. 2010;30(1):52–60. doi:10.1055/s-0030-1247132
   PubMed Web of Science ®Google Scholar
• US Department of Health and Human Services. Common terminology criteria for adverse events version 5.0. Available from: https://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm#ctc_50. Accessed November 28, 2023.
   Google Scholar
• Chen K, Pan Y, Hu G-Y, et al. Laparoscopic versus open major hepatectomy for hepatocellular carcinoma: a meta-analysis. Surg Laparosc Endosc Percutan Tech. 2018;28(5):267–274. doi:10.1097/SLE.0000000000000567
   PubMed Web of Science ®Google Scholar
• Clavien P, Barkun J, de Oliveira M, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–196. doi:10.1097/SLA.0b013e3181b13ca2
   PubMed Web of Science ®Google Scholar
• Rahbari N, Garden O, Padbury R, et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery. 2011;149(5):713–724. doi:10.1016/j.surg.2010.10.001
   PubMed Web of Science ®Google Scholar
• Dioguardi Burgio M, Sartoris R, Libotean C, et al. Lipiodol retention pattern after TACE for HCC is a predictor for local progression in lesions with complete response. Cancer Imaging. 2019;19(1):75. doi:10.1186/s40644-019-0260-2
   PubMed Web of Science ®Google Scholar
• Austin P. Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat. 2011;10(2):150–161. doi:10.1002/pst.433
   PubMed Web of Science ®Google Scholar
• Zhao H, Cai J. Chinese expert consensus on neoadjuvant and conversion therapies for hepatocellular carcinoma. World J Gastroenterol. 2021;27(47):8069–8080. doi:10.3748/wjg.v27.i47.8069
   PubMed Web of Science ®Google Scholar
• Shindoh J, Kawamura Y, Kobayashi Y, et al. Prognostic impact of surgical intervention after lenvatinib treatment for advanced hepatocellular carcinoma. Ann Surg Oncol. 2021;28(12):7663–7672. doi:10.1245/s10434-021-09974-0
   PubMed Web of Science ®Google Scholar
• Zhang Y, Huang G, Wang Y, et al. Is salvage liver resection necessary for initially unresectable hepatocellular carcinoma patients downstaged by transarterial chemoembolization? Ten years of experience. Oncologist. 2016;21(12):1442–1449. doi:10.1634/theoncologist.2016-0094
   PubMed Web of Science ®Google Scholar
• Chung T, Leung T, Chung C, et al. Ablative-transarterial radioembolization resulting in complete histopathological response of hepatocellular carcinoma in the resected liver specimen after salvage hepatectomy. Int J Surg Case Rep. 2022;90:106679. doi:10.1016/j.ijscr.2021.106679
   PubMed Web of Science ®Google Scholar
• Kudo M, Aoki T, Ueshima K, et al. Achievement of complete response and drug-free status by atezolizumab plus bevacizumab combined with or without curative conversion in patients with transarterial chemoembolization-unsuitable, intermediate-stage hepatocellular carcinoma: a multicenter proof-of-concept study. Liver Cancer. 2023;12(4):321–338. doi:10.1159/000529574
   PubMed Web of Science ®Google Scholar
• Gan L, Lang M, Tian X, et al. A retrospective analysis of conversion therapy with lenvatinib, sintilimab, and arterially-directed therapy in patients with initially unresectable hepatocellular carcinoma. J Hepatocell Carcinoma. 2023;10:673–686. doi:10.2147/JHC.S404675
   PubMed Web of Science ®Google Scholar
• Shimose S, Iwamoto H, Shirono T, et al. The impact of curative conversion therapy aimed at a cancer-free state in patients with hepatocellular carcinoma treated with atezolizumab plus bevacizumab. Cancer Med. 2023;12(11):12325–12335. doi:10.1002/cam4.5931
   PubMed Web of Science ®Google Scholar
• Ren Z, Xu J, Bai Y, et al. Sintilimab plus a bevacizumab biosimilar (IBI305) versus sorafenib in unresectable hepatocellular carcinoma (ORIENT-32): a randomised, open-label, Phase 2–3 study. Lancet Oncol. 2021;22(7):977–990. doi:10.1016/S1470-2045(21)00252-7
   PubMed Web of Science ®Google Scholar
• Kudo M, Finn RS, Qin S, et al. Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: a randomised Phase 3 non-inferiority trial. Lancet. 2018;391(10126):1163–1173. doi:10.1016/S0140-6736(18)30207-1
   PubMed Web of Science ®Google Scholar
• Finn RS, Ikeda M, Zhu AX, et al. Phase Ib study of lenvatinib plus pembrolizumab in patients with unresectable hepatocellular carcinoma. J Clin Oncol. 2020;38(26):2960–2970. doi:10.1200/JCO.20.00808
   PubMed Web of Science ®Google Scholar
• Xu JM, Shen J, Gu SZ, et al. Camrelizumab in combination with apatinib in patients with advanced hepatocellular carcinoma (RESCUE): a nonrandomized, open-label, Phase II trial. Clin Cancer Res. 2021;27(4):1003–1011. doi:10.1158/1078-0432.CCR-20-2571
   PubMed Web of Science ®Google Scholar
• Qin S, Ren Z, Feng YH, et al. Atezolizumab plus bevacizumab versus sorafenib in the Chinese subpopulation with unresectable hepatocellular carcinoma: phase 3 randomized, open-label IMbrave150 study. Liver Cancer. 2021;10(4):296–308. doi:10.1159/000513486
   PubMed Web of Science ®Google Scholar
• Wu JY, Zhang ZB, Zhou JY, et al. Outcomes of salvage surgery for initially unresectable hepatocellular carcinoma converted by transcatheter arterial chemoembolization combined with lenvatinib plus anti-PD-1 antibodies: a multicenter retrospective study. Liver Cancer. 2023;12(3):229–237. doi:10.1159/000528356
   PubMed Web of Science ®Google Scholar
• Luo L, He Y, Zhu G, et al. Hepatectomy after conversion therapy for initially unresectable HCC: what is the difference? J Hepatocell Carcinoma. 2022;9:1353–1368. doi:10.2147/JHC.S388965
   PubMed Web of Science ®Google Scholar
• Habr-Gama A, Perez R, Nadalin W, et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg. 2004;240(4):711–717; discussion 717–718. doi:10.1097/01.sla.0000141194.27992.32
   Web of Science ®Google Scholar
• Wang QX, Zhang R, Xiao WW, et al. The watch-and-wait strategy versus surgical resection for rectal cancer patients with a clinical complete response after neoadjuvant chemoradiotherapy. Radiat Oncol. 2021;16(1):16. doi:10.1186/s13014-021-01746-0
   PubMed Web of Science ®Google Scholar
• Dattani M, Heald RJ, Goussous G, et al. Oncological and survival outcomes in watch and wait patients with a clinical complete response after neoadjuvant chemoradiotherapy for rectal cancer: a systematic review and pooled analysis. Ann Surg. 2018;268(6):955–967. doi:10.1097/SLA.0000000000002761
   PubMed Web of Science ®Google Scholar
• Renehan AG, Malcomson L, Emsley R, et al. Watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer (the OnCoRe project): a propensity-score matched cohort analysis. Lancet Oncol. 2016;17(2):174–183. doi:10.1016/S1470-2045(15)00467-2
   PubMed Web of Science ®Google Scholar
• Dossa F, Chesney TR, Acuna SA, et al. A watch-and-wait approach for locally advanced rectal cancer after a clinical complete response following neoadjuvant chemoradiation: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2017;2(7):501–513. doi:10.1016/S2468-1253(17)30074-2
   PubMed Web of Science ®Google Scholar