Value of the ratio of viable tumor cells in the prognostic evaluation for patients with unresectable hepatocellular carcinoma undergoing sequential surgery after conversional therapy
Objective To evaluate the prognostic value of the ratio of viable tumor cells(RVTCs)in patients with initially unresectable hepatocellular carcinoma(HCC)treated with sequential surgery after immunotherapy combined with targeted therapy.Methods Clinical data of 80 patients with initially unre-sectable HCC undergoing sequential surgery after immunotherapy combined with targeted therapy in the Fac-ulty of Hepato-Pancreato-Biliary Surgery,the First Medical Center of Chinese PLA General Hospital from June 2019 to June 2022 were retrospectively analyzed,including 70 males and 10 females,aged(54.5± 10.9)years old.Patients underwent sequential surgery after conversional therapy based on programmed death-1 antibody combined with tyrosine kinase inhibitor.RVTCs in postoperative pathological specimens were calculated.The postoperative treatment and survival of patients were followed up by medical record system,outpatient system data and telephone review.The receiver operating characteristic(ROC)curve was used to analyze the relationship between RVTCs and recurrence-free survival(RFS)and its best cut-off value.The Kaplan-Meier method was used for survival analysis,and the survival rates were compared using log-rank test.Multivariate logistic regression analysis was used to analyze the influencing factors of progno-sis.Results No viable tumor cells were found in the tumor specimens of 17 patients,which indicated that the RVTCs was 0 and complete pathological response(CPR)was achieved.According to postoperative pathology,patients were divided into the CPR group(n=17)and non-CPR group(n=63).The postopera-tive RFS and overall survival(OS)in the CPR group were better than those in the non-CPR group(both P＜0.05).The area under the ROC curve of RVTCs for predicting the 1-,2-,and 3-year RFS with initially unresectable HCC was 0.850,0.880,and 0.788,respectively.The cut-off values of RVTCs were all 15％,so the best cut-off value of RVTCS was set up as 15％.Patients were then divided into the RVTCs＞15％group(n=37)and RVTCs≤15％group(n=43).The RFS and OS of patients with RVTCs≤15％were better than those in patients with RVTCs＞15％(both P＜0.05).Multivariate logistic regression analysis showed that patients with hepatitis B virus infection(OR=8.114,95％CI:1.343-49.044,P=0.023),defined as compelete response or partial response based on preoperative modified respond evaluation criteria in solid tumors(OR=4.423,95％CI:0.976-20.050,P=0.042),and preoperative alpha-fetoprotein ≤20 μg/L(OR=5.939,95％CI:1.576-22.383,P=0.008)were risk factors for RVTCs≤15％in surgi-cal specimens.Conclusion RVTCs can be used as a prognostic marker in patients with initially unresect-able HCC undergoing sequential surgery after immunotherapy combined with targeted therapy,which is correlated with the RFS and OS of patients.
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