Annals of gastroenterological surgery · 2025
Surgical and Oncological Outcomes of Conversion Surgery After Hepatic Arterial Infusion Chemotherapy for Initially Unresectable Locally Advanced Hepatocellular Carcinoma.
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Goto Yuichi, Mihara Yutaro, Niizeki Takashi, Sakai Hisamune, Ogasawara Sachiko, Akiba Jun, Yano Hirohisa, Kawaguchi Takumi, Fujita Fumihiko, Hisaka Toru
Аннотация
BACKGROUND: Since 2013, we have performed conversion surgery after hepatic arterial infusion chemotherapy (HAIC) for initially unresectable locally advanced hepatocellular carcinoma (LA-HCC).
METHODS: Between 2013 and 2021, we assessed the surgical and oncological outcomes and pathological findings of patients with LA-HCC without extrahepatic spread (EHS) whose tumors converted from unresectable to resectable status with the New-FP regimen HAIC.
RESULTS: We censored 153 patients with LA-HCC (Child-Pugh A, without EHS) indicated for HAIC. Among them, 25 converted to resectable status after HAIC. Antitumoral effects were Response Evaluation Criteria in Solid Tumors (RECIST) partial response in 13/25 cases (52%) and modified RECIST complete response in 14/25 cases (56%). We performed hepatectomy for 24 cases because one case was lost to unexpected liver failure after portal vein embolization. No severe complications were recorded after hepatectomy. The 5-year overall survival rate was 56%. When resected specimens were assessed as whole tissue sections, all showed various degrees of necrosis (median rate of necrotic nodules: 90%), and 7 had complete necrosis. We also classified patterns of residual tumors into intratumoral and peritumoral types, with the former divided into a peripheral and a nonperipheral type. All cases with complete necrosis survived, and recurrence of the peripheral type was less frequent than other residual patterns (p = 0.0451). All patients whose residual tumors contained a peritumoral pattern experienced recurrence within roughly 12 months.
CONCLUSIONS: New-FP regimen HAIC achieved favorable surgical and oncological outcomes and could be adopted as a conversion chemotherapy. In addition, different residual tumor patterns demonstrated different prognoses.
METHODS: Between 2013 and 2021, we assessed the surgical and oncological outcomes and pathological findings of patients with LA-HCC without extrahepatic spread (EHS) whose tumors converted from unresectable to resectable status with the New-FP regimen HAIC.
RESULTS: We censored 153 patients with LA-HCC (Child-Pugh A, without EHS) indicated for HAIC. Among them, 25 converted to resectable status after HAIC. Antitumoral effects were Response Evaluation Criteria in Solid Tumors (RECIST) partial response in 13/25 cases (52%) and modified RECIST complete response in 14/25 cases (56%). We performed hepatectomy for 24 cases because one case was lost to unexpected liver failure after portal vein embolization. No severe complications were recorded after hepatectomy. The 5-year overall survival rate was 56%. When resected specimens were assessed as whole tissue sections, all showed various degrees of necrosis (median rate of necrotic nodules: 90%), and 7 had complete necrosis. We also classified patterns of residual tumors into intratumoral and peritumoral types, with the former divided into a peripheral and a nonperipheral type. All cases with complete necrosis survived, and recurrence of the peripheral type was less frequent than other residual patterns (p = 0.0451). All patients whose residual tumors contained a peritumoral pattern experienced recurrence within roughly 12 months.
CONCLUSIONS: New-FP regimen HAIC achieved favorable surgical and oncological outcomes and could be adopted as a conversion chemotherapy. In addition, different residual tumor patterns demonstrated different prognoses.