Comparison of survival benefit and safety between surgery following conversion therapy versus surgery alone in patients with surgically resectable hepatocellular carcinoma at CNLC IIb/IIIa stage: a propensity score matching study

Abstract

Objective: The objective of this study is to evaluate and compare the survival benefit and safety of surgery following conversion therapy versus surgery alone in patients diagnosed with surgically resectable hepatocellular carcinoma (HCC) at China Liver Cancer Staging (CNLC) IIb/IIIa stage. Methods: A total of 95 patients diagnosed with surgically resectable CNLC IIb/IIIa HCC were retrospectively enrolled in our study from November 2018 to December 2022. Among them, 30 patients underwent conversion therapy followed by hepatectomy, while the remaining 65 received surgery alone. The primary endpoint was recurrence-free survival (RFS). Propensity score matching (PSM) was employed to minimize bias in the retrospective analysis. Results: Compared to the surgery alone group, the conversion therapy group demonstrated a significantly prolonged median RFS (17.1 vs. 7.0 months; P=0.014), a reduced incidence of microvascular invasion (MVI, 23.3% vs. 81.5%; P<0.001), and a comparable rate of achieving Textbook Outcome in Liver Surgery (TOLS, 83.3% vs. 76.9%; P=0.476). Multivariate analysis indicated that conversion therapy was independently associated with improved RFS after hepatectomy (HR=0.511, P=0.027). The same conclusions were obtained after PSM. Conclusions: The findings of our study offer preliminary evidence that preoperative conversion therapy significantly prolongs RFS in patients with surgically resectable HCC at CNLC IIb/IIIa stage. Furthermore, combining conversion therapy and hepatectomy represents a relatively safe treatment strategy.

A commentary on ‘Comparison of survival benefit and safety between surgery following conversion therapy versus surgery alone in patients with surgically resectable hepatocellular carcinoma at CNLC IIb/IIIa stage: a propensity score matching study’

“…We found that the retrospective propensity score matching study recently published by Ma et al . 3 on preoperative adjuvant therapy for HCC to be of interest. This study reported a comparison of the safety and survival benefits of preoperative adjuvant therapy combined with surgical resection versus direct surgical resection alone in patients with stage CNLC Ⅱb/Ⅲa HCC.…”