Survival Outcomes, Recurrence Patterns, and Its Corresponding Therapeutic Management after Conversion Therapy...

Area of Science:

• Hepatobiliary Surgery
• Oncology
• Gastroenterology

Background:

• Limited research exists on long-term outcomes, adjuvant therapy, and recurrence patterns after conversion resection for initially unresectable hepatocellular carcinoma (uHCC).
• Understanding these factors is crucial for optimizing treatment strategies in this patient population.

Purpose of the Study:

• To comprehensively evaluate clinical outcomes, including overall survival (OS) and recurrence-free survival (RFS), after conversion resection in patients with initially uHCC.
• To investigate the impact of adjuvant therapy and recurrence patterns on patient prognosis.

Main Methods:

• Retrospective analysis of 419 patients with initially uHCC who underwent conversion resection.
• Primary endpoints: OS and overall survival after recurrence (rOS). Secondary endpoint: RFS.
• Recurrence patterns classified using the Barcelona Clinic Liver Cancer (BCLC) staging system (rBCLC).

Main Results:

• Median OS was not reached, and median RFS was 16.8 months. Achieving complete response (CR) or significant pathological response predicted better OS and RFS.
• Postoperative adjuvant therapy did not significantly improve OS or RFS compared to active surveillance.
• Recurrence occurred in 62.3% of patients; curative treatment was optimal for recurrence, and combination therapy showed no superior efficacy over other treatments.

Conclusions:

• Conversion resection leads to a favorable prognosis for patients with initially uHCC.
• Tumor response to conversion therapy is a key predictor of post-resection outcomes.
• Routine use of postoperative adjuvant therapy is not supported; aggressive treatments for recurrence lack evidence.