Introduction Transarterial chemoembolization combined with lenvatinib and PD-1 inhibitor (triple therapy) has displayed encouraging clinical outcomes for unresectable hepatocellular carcinoma (uHCC). We aimed to explore the prognostic value of pathological response (PR) in patients with initially uHCC who underwent conversion surgery following triple therapy and identify predictors of major pathological response (MPR). Methods A total of 76 patients with initially uHCC who underwent conversion surgery following triple therapy were retrospectively analyzed. PR was calculated as the proportion of nonviable tumor cell surface area of the whole tumor bed surface area. MPR was identified when PR was ≥90%. Pathological complete response (pCR) was defined as the absence of viable tumor cells. Results MPR and pCR were identified in 53 (69.7%) and 25 (32.9%) patients, respectively. The 1- and 2-year overall survival in patients with MPR were significantly higher than in those without MPR (100.0% and 91.3% vs. 67.7% and 19.4%; p < 0.001). The corresponding recurrence-free survival was also improved in patients with MPR compared to those without (75.9% and 50.8% vs. 22.3% and 11.2%; p < 0.001). Similar results were observed among patients with pCR and those without. Patients who achieved MPR without pCR exhibited survival rates comparable to those of patients who achieved pCR. Baseline neutrophil-to-lymphocyte ratio ≥2.6 (p = 0.016) and preoperative alpha-fetoprotein level ≥400 ng/mL (p = 0.015) were independent predictors of MPR. Conclusion The presence of MPR or pCR could improve prognosis in patients with initially uHCC who underwent conversion surgery following triple therapy. The PR may become a surrogate marker for predicting the prognosis of these patients.

中文翻译：

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接受转化手术的不可切除肝细胞癌患者病理反应的预后价值。


简介 经动脉化疗栓塞联合 lenvatinib 和 PD-1 抑制剂 （三联疗法） 对不可切除的肝细胞癌 （uHCC） 显示出令人鼓舞的临床结果。我们旨在探讨三联疗法后接受转化手术的初始 uHCC 患者的病理反应 （PR） 的预后价值，并确定主要病理反应 （MPR） 的预测因子。方法 回顾性分析共 76 例三联治疗后接受转化手术的初始 uHCC 患者。PR 计算为无活力肿瘤细胞表面积占整个肿瘤床表面积的比例。当 PR 为 ≥90% 时确定 MPR。病理完全缓解 （pCR） 定义为不存在活的肿瘤细胞。结果 分别在 53 例 （69.7%） 和 25 例 （32.9%） 患者中检测到 MPR 和 pCR。MPR 患者的 1 年和 2 年总生存率显著高于无 MPR 的患者 （100.0% 和 91.3% vs. 67.7% 和 19.4%;p < 0.001）。与无 MPR 患者相比，MPR 患者相应的无复发生存期也有所改善 （75.9% 和 50.8% vs. 22.3% 和 11.2%;p < 0.001）。在 pCR 患者和无 pCR 患者中观察到类似的结果。达到 MPR 但未 pCR 的患者表现出与达到 pCR 的患者相当的生存率。基线中性粒细胞与淋巴细胞比值 ≥2.6 （p = 0.016） 和术前甲胎蛋白水平 ≥400 ng/mL （p = 0.015） 是 MPR 的独立预测因子。结论 MPR 或 pCR 的存在可以改善三联治疗后接受转化手术的初始 uHCC 患者的预后。PR 可能成为预测这些患者预后的替代标志物。