Conversion Surgery After HAIC-Based Combination Therapy with Targeted Therapy and Immune Checkpoint Inhibitors for Initially Unresectable Hepatocellular Carcinoma: A Retrospective Cohort Study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: For selected patients whose initially unresectable hepatocellular carcinoma (HCC) responds to hepatic arterial infusion chemotherapy (HAIC)-based combination treatment, conversion surgery may provide an opportunity for curative-intent management. We quantified the frequency of conversion surgery, examined factors associated with surgical conversion, and assessed survival and pathological outcomes using analyses that accounted for immortal time bias. Methods: We conducted a single-center retrospective cohort study of 216 patients with initially unresectable HCC who received HAIC together with targeted therapy and immune checkpoint blockade from September 2020 through June 2023. The relationship between conversion surgery and survival was examined with time-dependent Cox regression and a prespecified 180-day landmark analysis. Two hepatopathologists independently assessed the pathological response. Results: 47 (21.8%) patients underwent conversion surgery, and 16 (34.0%) achieved pathological complete response (pCR). Median overall survival (OS) was 22.7 months (95% confidence interval [CI], 21.1– 25.8), and median progression-free survival (PFS) was 13.7 months (95% CI, 10.9– 16.2). In adjusted 180-day landmark analyses including 211 patients for OS and 166 patients for PFS, conversion surgery was associated with lower hazards of death (hazard ratio [HR], 0.30; 95% CI, 0.16– 0.59; P < 0.001) and progression or death (HR, 0.32; 95% CI, 0.16– 0.64; P = 0.001); time-dependent Cox models produced consistent findings. Albumin ≥ 35 g/L was associated with higher odds of conversion surgery (odds ratio [OR], 5.47; 95% CI, 1.75– 17.06), whereas multifocal tumors were associated with lower odds (OR, 0.13; 95% CI, 0.06– 0.29). Among resected patients, pCR was associated with favorable postoperative outcomes in exploratory unadjusted analyses. Conclusion: 47 of 216 patients (21.8%) underwent conversion surgery after HAIC-based combination therapy. Conversion surgery was associated with favorable OS and PFS after accounting for treatment timing. However, causal inference remains limited by residual confounding and treatment-selection bias in this retrospective study. The prognostic value of pCR requires validation in larger prospective cohorts. Keywords: hepatocellular carcinoma, conversion surgery, hepatic arterial infusion chemotherapy, immunotherapy, pathological complete response, immortal time bias
DOI: 10.2147/jhc.s644129
Institutions: Hubei University of Medicine, Taihe Hospital
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,836
OpenAlex ID: W7224018718