{"title":"最初不可切除的局部晚期肝细胞癌肝动脉输注化疗后转换手术的外科和肿瘤学结果","authors":"Yuichi Goto, Yutaro Mihara, Takashi Niizeki, Hisamune Sakai, Sachiko Ogasawara, Jun Akiba, Hirohisa Yano, Takumi Kawaguchi, Fumihiko Fujita, Toru Hisaka","doi":"10.1002/ags3.70034","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Since 2013, we have performed conversion surgery after hepatic arterial infusion chemotherapy (HAIC) for initially unresectable locally advanced hepatocellular carcinoma (LA-HCC).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Between 2013 and 2021, we assessed the surgical and oncological outcomes and pathological findings of patients with LA-HCC without extrahepatic spread (EHS) whose tumors converted from unresectable to resectable status with the New-FP regimen HAIC.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>We censored 153 patients with LA-HCC (Child-Pugh A, without EHS) indicated for HAIC. Among them, 25 converted to resectable status after HAIC. Antitumoral effects were Response Evaluation Criteria in Solid Tumors (RECIST) partial response in 13/25 cases (52%) and modified RECIST complete response in 14/25 cases (56%). We performed hepatectomy for 24 cases because one case was lost to unexpected liver failure after portal vein embolization. No severe complications were recorded after hepatectomy. The 5-year overall survival rate was 56%. When resected specimens were assessed as whole tissue sections, all showed various degrees of necrosis (median rate of necrotic nodules: 90%), and 7 had complete necrosis. We also classified patterns of residual tumors into intratumoral and peritumoral types, with the former divided into a peripheral and a nonperipheral type. All cases with complete necrosis survived, and recurrence of the peripheral type was less frequent than other residual patterns (<i>p</i> = 0.0451). All patients whose residual tumors contained a peritumoral pattern experienced recurrence within roughly 12 months.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>New-FP regimen HAIC achieved favorable surgical and oncological outcomes and could be adopted as a conversion chemotherapy. In addition, different residual tumor patterns demonstrated different prognoses.</p>\n </section>\n </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"1075-1085"},"PeriodicalIF":3.3000,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70034","citationCount":"0","resultStr":"{\"title\":\"Surgical and Oncological Outcomes of Conversion Surgery After Hepatic Arterial Infusion Chemotherapy for Initially Unresectable Locally Advanced Hepatocellular Carcinoma\",\"authors\":\"Yuichi Goto, Yutaro Mihara, Takashi Niizeki, Hisamune Sakai, Sachiko Ogasawara, Jun Akiba, Hirohisa Yano, Takumi Kawaguchi, Fumihiko Fujita, Toru Hisaka\",\"doi\":\"10.1002/ags3.70034\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Since 2013, we have performed conversion surgery after hepatic arterial infusion chemotherapy (HAIC) for initially unresectable locally advanced hepatocellular carcinoma (LA-HCC).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Between 2013 and 2021, we assessed the surgical and oncological outcomes and pathological findings of patients with LA-HCC without extrahepatic spread (EHS) whose tumors converted from unresectable to resectable status with the New-FP regimen HAIC.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>We censored 153 patients with LA-HCC (Child-Pugh A, without EHS) indicated for HAIC. Among them, 25 converted to resectable status after HAIC. Antitumoral effects were Response Evaluation Criteria in Solid Tumors (RECIST) partial response in 13/25 cases (52%) and modified RECIST complete response in 14/25 cases (56%). We performed hepatectomy for 24 cases because one case was lost to unexpected liver failure after portal vein embolization. No severe complications were recorded after hepatectomy. The 5-year overall survival rate was 56%. When resected specimens were assessed as whole tissue sections, all showed various degrees of necrosis (median rate of necrotic nodules: 90%), and 7 had complete necrosis. We also classified patterns of residual tumors into intratumoral and peritumoral types, with the former divided into a peripheral and a nonperipheral type. All cases with complete necrosis survived, and recurrence of the peripheral type was less frequent than other residual patterns (<i>p</i> = 0.0451). All patients whose residual tumors contained a peritumoral pattern experienced recurrence within roughly 12 months.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>New-FP regimen HAIC achieved favorable surgical and oncological outcomes and could be adopted as a conversion chemotherapy. In addition, different residual tumor patterns demonstrated different prognoses.</p>\\n </section>\\n </div>\",\"PeriodicalId\":8030,\"journal\":{\"name\":\"Annals of Gastroenterological Surgery\",\"volume\":\"9 5\",\"pages\":\"1075-1085\"},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2025-05-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70034\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Gastroenterological Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/ags3.70034\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Gastroenterological Surgery","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ags3.70034","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Surgical and Oncological Outcomes of Conversion Surgery After Hepatic Arterial Infusion Chemotherapy for Initially Unresectable Locally Advanced Hepatocellular Carcinoma
Background
Since 2013, we have performed conversion surgery after hepatic arterial infusion chemotherapy (HAIC) for initially unresectable locally advanced hepatocellular carcinoma (LA-HCC).
Methods
Between 2013 and 2021, we assessed the surgical and oncological outcomes and pathological findings of patients with LA-HCC without extrahepatic spread (EHS) whose tumors converted from unresectable to resectable status with the New-FP regimen HAIC.
Results
We censored 153 patients with LA-HCC (Child-Pugh A, without EHS) indicated for HAIC. Among them, 25 converted to resectable status after HAIC. Antitumoral effects were Response Evaluation Criteria in Solid Tumors (RECIST) partial response in 13/25 cases (52%) and modified RECIST complete response in 14/25 cases (56%). We performed hepatectomy for 24 cases because one case was lost to unexpected liver failure after portal vein embolization. No severe complications were recorded after hepatectomy. The 5-year overall survival rate was 56%. When resected specimens were assessed as whole tissue sections, all showed various degrees of necrosis (median rate of necrotic nodules: 90%), and 7 had complete necrosis. We also classified patterns of residual tumors into intratumoral and peritumoral types, with the former divided into a peripheral and a nonperipheral type. All cases with complete necrosis survived, and recurrence of the peripheral type was less frequent than other residual patterns (p = 0.0451). All patients whose residual tumors contained a peritumoral pattern experienced recurrence within roughly 12 months.
Conclusions
New-FP regimen HAIC achieved favorable surgical and oncological outcomes and could be adopted as a conversion chemotherapy. In addition, different residual tumor patterns demonstrated different prognoses.