Conversion therapy followed by surgery and adjuvant therapy improves survival in Barcelona C stage hepatocellular carcinoma ― A propensity score-matched analysis

Conversion therapy with a combination of tyrosine kinase inhibitor and anti-programmed death-1 antibody sequential surgery and postoperative adjuvant therapy has shown improved survival benefits in patients with Barcelona C stage (BCLC-C) hepatocellular carcinoma (HCC). We aimed to compare the survival benefits in a retrospective cohort of patients with BCLC-C HCC who underwent surgery after conversion therapy with adjuvant therapy and surgery alone. The conversion therapy group was derived from a prospective clinical study, and from January 2015 to September 2023, we selected patients diagnosed with BCLC-C HCC who underwent liver resection at Chinese PLA General Hospital as the surgical group. The primary endpoint in the comparison of survival benefits between conversion therapy and surgery-alone groups was recurrence-free survival. Propensity score matching was applied to reduce any potential bias in the study. By the end of follow-up, the conversion therapy group mRFS was 37.8 months, with postoperative 1-, 2- and 3-year RFS rates of 66.8%, 54.6%, and 48.3%. In the surgery group, the mRFS was 3.0 months, and postoperative 1- , 2- and 3-year RFS rates of 22.4%, 17.5%, and 15.0%, respectively. On multivariable Cox regression analyses, conversion therapy significantly reduced HCC-related mortality and HCC recurrence rates compared with surgery alone. For BCLC-C HCC patients, conversion therapy with adjuvant therapy is in relationship with increased survival in comparison with surgery alone.