Newly established borderline resectable 1 (BR1) category is one of the favorable candidates for selecting the use of multidisciplinary combination therapy in patients with advanced hepatocellular carcinoma treated with systemic therapy

Abstract

Background

The aim of this study was to evaluate the newly established oncological criteria of resectability of hepatocellular carcinoma (HCC) for selecting suitable candidates for systemic and combination therapy.

Methods

The data of 156 consecutive HCC patients with intrahepatic target nodules who had initially received systemic therapy (lenvatinib and atezolizumab plus bevacizumab) were reviewed. The patients were classified into three groups according to the novel oncological criteria for resectability (R, resectable; BR1, borderline resectable 1; and BR2, borderline resectable 2). The prognostic ability and clinical utility for selecting this population to receive combined use of multiple systemic sequential and locoregional therapy was then evaluated. Combined use of systemic sequential therapy with more than two agents and locoregional treatment was defined as multidisciplinary combination therapy (MCT), while systemic sequential therapy only and repeated locoregional treatment was defined as a single treatment procedure (STP).

Results

Patients classified as R and BR1 had significantly better overall survival (OS) compared with BR2 (R vs. BR2, p = 0.012; BR1 vs. BR2, p = 0.004). However, there was no significant difference between R and BR1 (p = 1.000), in spite of significantly worse oncological status in the BR1 patients. Following a R0 resection and MCT, the BR1 patients had significantly better OS compared with those receiving STP or no additional treatment (median OS, not reached vs. 25.2 months and 20.1 vs. 11.3 months, respectively; p = 0.034).

Conclusions

In patients with advanced HCC with intrahepatic target nodules the BR1 category is one of the favorable candidates for selecting those to be treated with MCT strategies.