Work

Resection rates after conversion therapy for initially unresectable hepatocellular carcinoma: a systematic review and meta-analysis

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Introduction: Conversion therapy may create an opportunity for liver resection in selected patients with initially unresectable hepatocellular carcinoma (HCC), but reported conversion rates use heterogeneous denominators and endpoints. We estimated actual completed hepatectomy using a verified all-treated denominator. Methods: PubMed/MEDLINE, Embase, Web of Science Core Collection, Cochrane Library/CENTRAL, Wanfang Data, and CNKI were searched through April 10, 2026. Eligible cohorts included initially or baseline unresectable HCC, an all-treated denominator, and completed liver resection events. Two authors independently assessed eligibility, extracted data, and evaluated risk of bias. Random-effects logit proportion meta-analysis, Hartung-Knapp sensitivity, prediction intervals, leave-one-out analyses, treatment-strategy subgroups, publication-year meta-regression, and small-study-effect diagnostics were undertaken. PROSPERO: CRD420261360108. Results: =0.5132). The Hartung-Knapp 95% CI was 20.12%-31.51%, and the prediction interval was 7.16%-60.04%. Leave-one-out estimates ranged from 24.52% to 26.64%. Treatment-strategy differences were not statistically significant (Qm=5.17, df=2, P = 0.075). Publication-year meta-regression did not show a clear linear association (OR per decade 1.19, 95% CI 0.77-1.83; P = 0.440), and Egger's test did not indicate significant funnel asymmetry (P = 0.381). Conclusions: Approximately one-quarter of patients initiating conversion therapy underwent actual hepatectomy, but the crude and modeled estimates differ because substantial heterogeneity changes random-effects study weighting. The pooled estimate is a cross-study, cross-era benchmark for multidisciplinary decision-making rather than a universal patient-level probability or a treatment-specific efficacy estimate. Systematic Review Registration: www.crd.york.ac.uk/prospero/, identifier CRD420261360108.

Source: Frontiers in Oncology

DOI: 10.3389/fonc.2026.1898480