[The perioperative safety analysis of conversion therapy for liver cancer: a single-center retrospective study]

Objective: To investigate the perioperative safety of patients with hepatocellular carcinoma (HCC) undergoing conversion therapy followed by sequential surgical resection. Methods: This study was designed as a retrospective case series. Clinical and pathological data were retrospectively collected from 45 patients with initially unresectable HCC who received conversion therapy followed by surgical treatment at the Department of Hepatobiliary Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, between January 2021 and April 2023. The cohort comprised 41 males and 4 females, with an age(M(IQR)) of 54.5(12.5)years (range: 31 to 74 years). According to the Child-Pugh classification, 44 patients were classified as grade A and one as grade B. The median maximum tumor diameter was 8.05(5.82)cm (range: 4.2 to 19.2 cm). Regarding the China Liver Cancer staging system: 24 cases (53.3%) were at stage Ⅰb, 5 cases (11.1%) at stage Ⅱa, 10 cases (22.2%) at stage Ⅱb, and 6 cases (13.4%) at stage Ⅲa. The clinical characteristics, efficacy and adverse reactions of conversion therapy, as well as perioperative and postoperative follow-up outcomes were analyzed. Overall survival (OS) and disease-free survival (DFS) curves were plotted using the Kaplan-Meier method. For comparion of survival rates among the three groups, if the initial P value was <0.05, multiple comparison correction was performed, followed by pairwise comparisons using the Log-rank test. Results: After conversion therapy, the objective response rate was 48.9% (22/45), and the disease control rate reached 100% (45/45). The postoperative pathological complete response (pCR) rate was 20.0% (9/45), and major pathological response (MPR) rate was 26.7% (12/45). During conversion therapy, 84.4% (38/45) patients developed treatment-related adverse reactions, mainly including liver dysfunction, hypertension, and hypoalbuminemia. In perioperative period, 55.6% (25/45) patients experienced surgery-related complications, with the most common being hypoalbuminemia, ascites, and infection. The 1-year and 3-year OS rates for the 45 patients were 93.33% and 80.42%, respectively, while the 1-year and 3-year DFS rates were 87.69% and 70.54%, respectively. The DFS in pCR group was significantly longer than that in MPR and non-MPR group (all P<0.05). However, there was no statistically significant difference in OS among the three groups (P>0.05). Conclusions: The risks of treatment-related adverse reactions and perioperative complications in conversion therapy for HCC are manageable. This therapeutic approach provides surgical opportunities and the potential for long-term survival for patients with initially unresectable HCC.