Conversion Surgery for Hepatocellular Carcinoma Following Molecular Therapy

Area of Science:

• Hepatobiliary Surgery
• Medical Oncology
• Gastroenterology

Background:

• Advanced hepatocellular carcinoma (HCC) treatment has evolved with targeted drugs and immune checkpoint inhibitors.
• First-line therapies like sorafenib and lenvatinib, and newer combinations like atezolizumab plus bevacizumab, have improved median survival to over 1.5 years.
• Radiological response does not always equate to pathological cure, necessitating further treatment strategies.

Purpose of the Study:

• To evaluate the efficacy of conversion surgery following molecular therapy for advanced HCC.
• To determine if conversion surgery improves long-term outcomes compared to monotherapy.
• To identify lenvatinib as a suitable agent for facilitating conversion surgery.

Main Methods:

• Analysis of a large cohort study focusing on lenvatinib treatment for advanced HCC.
• Assessment of conversion surgery rates and outcomes in patients treated with lenvatinib.
• Statistical comparison of disease-specific survival between patients undergoing conversion surgery and those on lenvatinib monotherapy.

Main Results:

• Lenvatinib demonstrated a high response rate, enabling conversion surgery in 8.4% of patients.
• Conversion surgery was associated with an estimated disease-specific survival of over 80% at three years.
• Curative resection following lenvatinib treatment was an independent predictor of improved disease-specific survival.

Conclusions:

• Conversion surgery after molecular therapy, especially with lenvatinib, is a promising strategy for advanced HCC.
• This approach significantly prolongs long-term outcomes and offers potential for curative resection.
• Further discussion on optimal drug selection and timing for conversion surgery is warranted.