Assessment of Survival Benefits Derived from Surgical Resection Subsequent to the Attainment of Complete Response upon Triple Therapy in Hepatocellular Carcinoma: A Multicenter Study

Introduction The necessity of surgical resection for hepatocellular carcinoma (HCC) patients who achieve clinical complete response following triple therapy (transarterial chemoembolization, targeted therapy and immunotherapy) remains controversial. Thus, this study aimed to compare survival outcomes between surgical resection and non-surgical management in these patients. Methods Between January 2018 and March 2024, 127 HCC patients who achieved clinical complete response following triple therapy were retrospectively included in this study. Patients were stratified into two groups based on whether they underwent surgical resection: the surgical resection group (n=62) and the non-surgical resection group (n=65). Clinical characteristics, imaging findings, pathological results, and long-term outcomes were compared. Propensity score matching was performed to mitigate the effect of potential confounders. Results In the surgical group, 44 of 62 patients (70.9%) achieved pathological complete response. The overall postoperative complication rate was 24.2%, with severe complications (grade III–IV) recorded in 8.1% of patients. After propensity score matching, 55 matched pairs were included. One-, two-, and three-year overall survival rates following clinical complete response were 96.0%, 90.8%, and 90.8% in the surgical group, compared to 91.3%, 85.8%, and 73.1% in the non-surgical group (P=0.013). Additionally, one-, two-, and three-year recurrence-free survival rates were 81.5%, 74.6%, and 74.6% in the surgical group, compared to 81.1%, 53.5%, and 35.7% in the non-surgical group (P=0.020). Finally, multivariate analysis identified surgical resection as an independent prognostic factor for both overall survival (hazard ratio [HR], 0.266; 95% confidence interval [CI], 0.087-0.817; P=0.021) and recurrence-free survival (HR, 0.457; 95% CI, 0.228-0.914; P=0.027). Conclusion For HCC patients achieving clinical complete response after triple therapy, surgical resection may confer significant survival benefits and should therefore be considered as an optional treatment method.