Preoperative systemic chemoimmunotherapy and sequential resection for unresectable hepatocellular carcinoma

Area of Science:

• Hepatobiliary Surgery
• Medical Oncology
• Gastroenterology

Background:

• Hepatocellular carcinoma (HCC) often presents at an unresectable stage, with limited treatment options and low response rates.
• Novel systemic chemoimmunotherapy regimens show promise in converting unresectable HCC to a resectable state.
• This approach aims to improve complete clinical remission rates in advanced HCC patients.

Purpose of the Study:

• To evaluate the surgical and pathologic outcomes of patients with initially unresectable HCC.
• To assess the efficacy of preoperative systemic chemoimmunotherapy followed by sequential resection.
• To analyze the complete clinical remission and survival rates in this patient cohort.

Main Methods:

• Fifteen patients with unresectable HCC received systemic chemoimmunotherapy (cisplatin, alpha-interferon, doxorubicin, 5-fluorouracil) for up to six cycles.
• Tumor response was assessed, and patients with significant regression underwent sequential resection with curative intent.
• Surgical and pathologic findings, treatment outcomes, and survival data were collected and analyzed.

Main Results:

• Fifteen of 150 patients (10%) achieved resectable disease after chemoimmunotherapy and underwent surgery.
• Eight patients (53%) had complete pathologic remission, and all 15 achieved complete clinical remission post-surgery.
• One-, two-, and three-year survival rates were 100%, 100%, and 53%, respectively, with 10 patients remaining in complete remission.

Conclusions:

• Combined modality treatment with systemic chemoimmunotherapy and surgical resection is effective for unresectable HCC.
• This strategy can lead to complete clinical remission and durable long-term disease control.
• Sequential resection following chemoimmunotherapy is a viable option for select patients with advanced HCC.