[Real-world efficacy analysis of immuno-targeted combined protocol as neoadjuvant regimen for high-risk recurrent...

Objective: To analyze and evaluate the real-world clinical efficacy of immuno-targeted combined protocol as a neoadjuvant regimen for high-risk recurrent hepatocellular carcinoma. Methods: This is a retrospective case-series study. Real-world data from patients with high-risk recurrent HCC who received neoadjuvant therapy at Faculty of Hepato-Pancreato-Biliary Surgery,the First Medical Center of Chinese People's Liberation Army General Hospital, from January 2019 to September 2025, were analyzed. The cohort included 46 patients,among which there were 38 male patients (82.6%) and 8 female patients (17.4%), with an age at initial diagnosis(M(IQR)) of 56.5(15.0) years (range: 35 to 73 years). According to the Barcelona Clinic Liver Cancer staging system,there were 19 cases of stage A,15 cases of stage B and 12 cases of stage C. Survival curves were plotted using the Kaplan-Meier method,and comparisons were performed using the Log-rank test. A Cox regression analysis was performed on factors that may influence postoperative recurrence in patients. Results: Based on the modified Response Evaluation Criteria in Solid Tumors,the results of preoperative assessment were: 10 patients achieved complete response,30 patients achieved partial response,and 6 patients achieved stable disease. Based on the proportion of residual viable tumor cells in pathological specimens,there were 28 patients achieved major pathological response or above (60.9%). For the 46 enrolled patients,the recurrence-free survival(RFS) rates at 1,2,3 years were 74.7%,54.6%,45.5%,respectively,with a median recurrence-free survival of 28 months. The overall survival rates at 1,2,3 years were 97.6%,95.1%,91.8%,respectively. Cox regression analysis indicated that preoperative alpha-fetoprotein (AFP)≥400 μg/L was an independent high-risk factor for tumor recurrence. The 46 patients were divided into two groups based on their preoperative AFP levels. The 1-and 2-year RFS rates in the AFP<400 μg/L group were significantly higher than those in the AFP≥400 μg/L group, with a statistically significant difference (P<0.05). Conclusion: Immuno-targeted combined protocol as a neoadjuvant regimen can bring encouraging short-term and long-term survival outcomes to patients with high-risk recurrent hepatocellular carcinoma.