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

Abstract

Abstract Background: Combination immunotherapy have gradually become the mainstay of systematic therapy for hepatocellular carcinoma (HCC), however, prescribing immunotherapies perioperatively has the potential to reduce tumor activity, while increasing the resection rate and improving prognoses. This study investigated 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 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), which highlighted a 30% reduction in tumor size. Pathological evaluation of postoperative specimens confirmed that 21.4% (n=3) achieved complete responses. 78.6% (n=11) achieved partial responses. 28.6% (n=4) encountered grade 3 or 4 AEs out of 14 patients. 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 the application of combination immunotherapy, patients should be comprehensively evaluated whether they meet the criteria for surgical resection. This surgical resection following by combination immunotherapy might effectively control tumor progression and could improve the prognosis at least for some patients with initially unresectable HCC.