The Application of Locoregional Therapy Combined With Systemic Therapy in the Perioperative Period of Huge Hepatocellular Carcinoma: A Retrospective Cohort Study

The Application of Locoregional Therapy Combined With Systemic Therapy in the Perioperative Period of Huge Hepatocellular Carcinoma: A Retrospective Cohort Study

This retrospective cohort study collected data of patients with huge hepatocellular carcinoma (HCC) treated between June 1, 2018, and December 31, 2023, through the hospital information system. Patients were divided into a neoadjuvant conversion-first cohort and an upfront surgery cohort based on whether they received preoperative locoregional therapy combined with targeted and immunotherapy. The conversion-first cohort was further stratified into a conversion surgery group and a non-surgery group according to whether curative-intent hepatectomy was ultimately achieved. The upfront surgery cohort was divided into a postoperative adjuvant therapy group and a postoperative surveillance group based on whether adjuvant immunotherapy was administered after surgery. The primary objective was to analyze differences in overall survival (OS) and progression-free survival (PFS) among the four groups and to evaluate the impact of neoadjuvant conversion therapy on the safety of hepatectomy.

Inclusion Criteria:

• pathologically or clinically diagnosed HCC with a tumor diameter exceeding 10 cm on initial computed tomography (CT) or magnetic resonance imaging (MRI);
• ≤ 3 tumor nodules;
• portal vein tumor thrombus (PVTT) that had not invaded the main portal vein or the contralateral branch of portal vein (Vp0-3 PVTT);
• absence of extrahepatic metastasis; (5) Child-Pugh score of 5-7 and Eastern Cooperative Oncology Group performance status of 0-1.

Exclusion Criteria:

• mixed tumors with HCC and cholangiocarcinoma;
• recurrent HCC;
• tumor thrombus invading the inferior vena cava;
• combined with any malignancy other than HCC;
• incomplete clinical or follow-up data.