| Objective(s): This study aims to analyze retrospectively data on different conversion therapy regimens,adverse reactions,and perioperative management of patients with advanced hepatocellular carcinoma in our center,and provide clinical experience on liver cancer conversion therapy in our center.Methods: This study retrospectively analyzed the clinical and pathological data of patients diagnosed with hepatocellular carcinoma for the initial diagnosis by clinical or pathological means in our center from April 2020 to April 2022.The effectiveness and conversion rate of different conversion therapy regimens were compared to explore the most suitable regimen for conversion therapy.According to the Common Terminology Criteria for Adverse Events version 5.0 of the American Cancer Center,the incidence of adverse reactions of different conversion therapy regimens was compared to explore the safety of conversion therapy.The incidence of perioperative complications in patients with conversion surgery for hepatocellular carcinoma was compared with that in patients with first stage surgical hepatocellular carcinoma to investigate whether conversion therapy increases the incidence of postoperative complications.The early postoperative recurrence rate was compared between patients with conversion surgery for hepatocellular carcinoma and patients with first stage surgical hepatocellular carcinoma to explore the postoperative management of patients with conversion surgery.Results: 1.This study included 114 patients with initially diagnosed advanced hepatocellular carcinoma,classified by CNLC staging: 32 cases(28.1%)were stage Ib,17 cases(14.9%)were stage IIa,27 cases(23.7%)were stage IIb,and 38 cases(33.3%)were stage IIIa.The median age of the patients was 55 years,with 99 male patients(86.8%),103 patients with a background of liver cirrhosis(90.4%),96 patients(84.2%)with a maximum tumor diameter greater than 5cm,and 38 patients(33.3%)with evidence of vascular invasion on imaging.2.According to the mRECIST evaluation criteria,the ORR was 45.8% and DCR was 70.8% for local interventional treatment,while the ORR was 81.6% and DCR was90.0% for local interventional therapy combined with targeted therapy.3.In terms of treatment safety,105 patients(92.1%)experienced treatment-related adverse reactions,with 45 patients(39.5%)experiencing grade 3-4 adverse reactions,and no patients experiencing grade 5 adverse reactions.4.Conversion therapy regimen and conversion rate: Among 114 patients with advanced liver cancer,24 patients(21.1%)received local interventional therapy with a median treatment frequency of 2 times,among which 7 cases achieved successful conversion with a conversion rate of 29.2%.8 patients(7.0%)received targeted therapy with an average treatment time of 8.71 months,among which 2 cases achieved successful conversion with a conversion rate of 25.0%.60 patients(52.6%)received local interventional therapy combined with targeted therapy,with a median course of 4courses,among which 23 cases achieved successful conversion with a conversion rate of 38.3%.2 patients(1.8%)received targeted combined with immune therapy with an average treatment time of 6.67±1.53 months,both without successful conversion.20patients(17.5%)received local interventional therapy combined with targeted and immune triple therapy,with a median treatment time of 8 months,among which 10 cases achieved successful conversion with a conversion rate of 50.0%.5.After sequential surgical treatment in 33(33.3%)HCC patients who received conversion therapy,complete radiological remission was achieved in 9(27.3%)patients,while complete pathological remission was achieved in 7(21.2%)patients.The incidence of surgical complications was 84.8%,and 7(21.2%)HCC patients had grade III or higher complications requiring management,including 1(3.0%)patient who died of postoperative chronic liver failure.The complication rate of 80 patients with the first stage surgical HCC was 63.8%,of which 12(15.0%)cases had grade III or higher complications.Early recurrence occurred in 10(30.3%)HCC patients after conversion surgery,including 7 cases(21.2%)of intrahepatic metastasis,2 cases(6.1%)of pulmonary recurrence,and 1 case(3.0%)with both intrahepatic and pulmonary recurrence.Conclusion(s): 1.Local interventional therapy combined with targeted therapy is the most commonly used conversion therapy regimen for intermediate to advanced stage HCC in this center.It has a higher objective response rate and conversion rate compared to monotherapy,and can achieve better tumor downstaging.It can be considered as the preferred treatment for intermediate to advanced stage HCC patients.2.The adverse reactions caused by the conversion therapy regimen for intermediate to advanced stage HCC are generally controllable.3.The incidence of postoperative complications in conversion surgery patients is comparable to that of early-stage liver cancer surgery patients,proving that conversion surgery is a safe and feasible treatment option for intermediate to advanced stage HCC patients. |
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