Safety and Prognostic Analysis of Surgical Resection after Conversion Therapy and Downgrading of Initial Unresectable Advanced Hepatocel-lular Carcinoma
Objective To investigate the safety and prognostic analysis of surgical resection after conversion therapy and downgrad-ing of initial unresectable advanced hepatocellular carcinoma.Methods Clinical data was retrospectivly collected from 53 unresectable advanced hepatocellular carcinoma patients who received combined treatment with tyrosine kinase inhibitor(TKI)and programmed death-1(PD-1)inhibitors in the Affiliated Hospital of Xuzhou Medical University from January 2019 to December 2021.Tumor re-sponse and resectability were evaluated through modified response evaluation criteria in solid tumors(mRECIST).Emphasis was placed on analyzing the clinical characteristics,effects of conversion therapy,adverse drug reactions,surgical outcomes,postoperative complica-tions and survival of patients undergoing surgical resection,in order to evaluate surgical safety and prognosis.Results Among 53 patients with initially unresectable advanced liver cancer,12 patients(22.6％)underwent R0 resection surgery within 101(92,153)days after the start of combination therapy.At the initial examination,the median maximum tumor diameter of these 12 patients was 8.2(4.7,10.3)cm,and 6 patients of them were in CNLC Ⅲ a stage;4 patients were in CNLC Ⅲ b stage,including 3 patients of retroperitoneal lymph node metastasis and 1 patient of left adrenal metastasis.Preoperative evaluation:2 patients showed complete remission,9 patients showed partial remission,and 1 patient showed stable disease.There were 3 patients of postoperative complications of grade Ⅱ or above.The cumulative postoperative survival rates at 6months,1 year,and 2 years were 100.0％,91.7％,and 66.7％,respectively.The re-currence-free survival rates at 6months,1 year,and 2 years were 91.7％,66.7％,and 50.0％,respectively.Conclusion After full preoperative evaluation,surgical resection is safe and effective for the initial unresectable advanced liver cancer after conversion therapy and downgrading.
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