Salvage surgery after combination immunotherapy for initially unresectable or metastastic hepatocellular carcinoma: A retrospective clinical study

Background

Combination immunotherapy has gradually become the mainstay of systematic therapy for advanced hepatocellular carcinoma (HCC), however, whether preoperative immunotherapy has the potential to reduce tumor activity, increase the resection rate and improve prognosis remains unclear. This study aimed to investigate the efficacy and safety of preoperative combined immunotherapies for patients with initially unresectable HCC.

Methods

This retrospective, real-world study involved patients with initially unresectable HCC receiving combined immunotherapies based on PD-1/L1 blockade before surgery. Tumor treatment responses, pathological manifestations in postoperative specimens and overall survival (OS) were evaluated. Treatment related adverse events (AEs) were assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE, version 4.0).

Results

The study consecutively included 54 initially unresectable HCC patients and 34 patients were evaluated for the safety, efficacy, and possibility of subsequent radical surgery. Among these patients with surgical resection, 57.1% (n=8) receiving combination immunotherapy before surgery achieved a partial response (PR). Pathological evaluation of postoperative specimens confirmed that 21.4% (n=3) achieved complete responses, and 78.6% (n=11) achieved PR. 28.6% (4/14) patients encountered grade 3 or 4 AEs. The main AEs included fatigue (n=11; 78.6%), leukocytopenia (n=8; 57.1%) and aspartate aminotransferase (AST) elevation (n=6; 42.9%).

Conclusions

After combination immunotherapy, patients should be comprehensively evaluated whether they meet the criteria for surgical resection. Surgical resection following combination immunotherapy might effectively and safely control tumor progression and could improve the prognosis at least for some patients with initially unresectable HCC.