Triple combination conversion therapy, involving transcatheter arterial chemoembolization (TACE) or hepatic arterial infusion chemotherapy (HAIC) combined with tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs), has shown an encouraging objective response rate (ORR) and successful conversion surgery rate in initially unresectable hepatocellular carcinoma (HCC). However, the safety and long-term survival outcomes of subsequent liver resection after successful conversion still remain to be validated. From February 2019 to February 2023, 726 patients were enrolled in this retrospective study (75 patients received hepatectomy after conversion therapy [CLR group], and 651 patients underwent pure hepatectomy [LR group]). Propensity score matching (PSM) was used to balance the preoperative baseline characteristics. After PSM, 68 patients in the CLR group and 124 patients in the LR group were analyzed, and all the matching variables were well-balanced. Compared with the LR group, the CLR group experienced longer Pringle maneuver time, longer operation time, and longer hospital stays. In addition, the CLR group had significantly higher incidence rates of intra-abdominal bleeding, biliary leakage, post-hepatectomy liver failure (PHLF), and Clavien–Dindo grade IIIa complications than the LR group. There were no significant statistical differences in overall survival (OS) (hazard ratio [HR] 0.724; 95% confidence interval [CI] 0.356–1.474;p= 0.374) and recurrence-free survival (RFS) (HR 1.249; 95% CI 0.807–1.934;p= 0.374) between the two groups. Liver resection following triple combination conversion therapy in initially unresectable HCC may achieve favorable survival outcomes with manageable safety profiles; presenting as a promising treatment option for initially unresectable HCC.
三联转化疗法，即经导管动脉化疗栓塞（TACE）或肝动脉灌注化疗（HAIC）联合酪氨酸激酶抑制剂（TKIs）与免疫检查点抑制剂（ICIs），在初始不可切除肝细胞癌（HCC）中显示出令人鼓舞的客观缓解率（ORR）和成功的转化手术率。然而，成功转化后行肝切除术的安全性及长期生存结局仍有待验证。本研究回顾性纳入2019年2月至2023年2月期间的726例患者（其中75例在转化治疗后接受肝切除术[CLR组]，651例接受单纯肝切除术[LR组]）。采用倾向评分匹配（PSM）平衡术前基线特征。经PSM后，对CLR组68例患者和LR组124例患者进行分析，所有匹配变量均达到良好平衡。与LR组相比，CLR组的Pringle阻断时间、手术时间和住院时间均更长。此外，CLR组的腹腔内出血、胆漏、肝切除术后肝衰竭（PHLF）以及Clavien–Dindo IIIa级并发症的发生率显著高于LR组。两组在总生存期（OS）（风险比[HR] 0.724；95%置信区间[CI] 0.356–1.474；p=0.374）和无复发生存期（RFS）（HR 1.249；95% CI 0.807–1.934；p=0.374）方面无显著统计学差异。对于初始不可切除的HCC，三联转化治疗后行肝切除术可在可接受的安全性范围内获得良好的生存结局，为初始不可切除HCC提供了一种有前景的治疗选择。
肿瘤(癌症)患者之家