Conversion Therapy Based on TACE/HAIC-Based Treatment to Improve the Therapeutic Effect of Initially Unresectable Hepatocellular Carcinoma

Objectives: The main objectives of this research are to evaluate the outcomes of patients with initially unresectable hepatocellular carcinoma (HCC) who received transcatheter arterial chemoembolization (TACE)/hepatic artery infusion chemotherapy (HAIC)-based combination therapy, and to investigate the effects of liver resection following comprehensive conversion therapy on the short-term benefit and long-term survival of these patients. Materials and methods: A total of 301 initially unresectable HCC patients who received TACE/HAIC-based combination therapy between January 2019 and December 2021 were retrospectively reviewed. The study analyzed the conversion rate to resection, changes in tumor burden after treatment, and the survival outcomes. Results: The study found that 20.9% (63/301) of initially unresectable HCC patients were able to undergo liver resection. The conversion resection rate among all patients was 38.2% (29/76) and 17.3% (23/132) for those with BCLC stage A and C. Patients who underwent surgery achieved promising outcomes with a pathologic complete response (pCR) rate of 31.7% (20/63) and a 100% R0 resection rate. Kaplan-Meier survival analysis showed that patients who had successful surgery after conversion therapy had significantly longer median overall survival (OS) (not reached vs. 58.5 months) and progression free survival (PFS) (42.83 months vs. 9.7 months) compared to those who did not (both p<0.05). Additionally, patients achieving radiographic complete response (CR) had significantly better OS and PFS than those who did not. Multivariable logistic regression analysis shows that age (OR=0.95, p<0.001), positive HBsAg expression (OR=0.34, p=0.011), and AFP levels ≥ 400 (OR=0.49, p=0.045), ECOG PS score 1 (OR=0.43, p=0.038), BCLC stage B (OR=0.23, p<0.001) and stage C (OR=0.44, p=0.045), SIRI (OR=0.73, p=0.018) were independent predictors for successful conversion surgery (all p<0.05). Conclusion: Patients with initially unresectable HCC could achiever promising curative effects and conversion resection rates with TACE/HAIC-based comprehensive therapy. More importantly, patients who undergo liver resection following conversion resection had a significant better long-term survival.