Is liver resection still required for patients who have predictive factors for complete pathologic necrosis after downstaging treatments of locally advanced hepatocellular carcinoma?

Munseok Choi; Dai Hoon Han; Kyung Sik Kim; Jin Sub Choi; Beom Kyung Kim; Seung Up Kim; Jinsil Seong; Do Young Kim; Gi Hong Choi

doi:10.1016/j.ejso.2024.109349

Is liver resection still required for patients who have predictive factors for complete pathologic necrosis after downstaging treatments of locally advanced hepatocellular carcinoma?

Eur J Surg Oncol. 2024 Oct 28;51(1):109349. doi: 10.1016/j.ejso.2024.109349. Online ahead of print.

Authors

Munseok Choi¹, Dai Hoon Han², Kyung Sik Kim², Jin Sub Choi², Beom Kyung Kim³, Seung Up Kim³, Jinsil Seong⁴, Do Young Kim⁵, Gi Hong Choi⁶

Affiliations

¹ Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, South Korea.
² Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
³ Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
⁴ Departments of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
⁵ Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. Electronic address: dyk1025@yuhs.ac.
⁶ Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. Electronic address: CHOIGH@yuhs.ac.

PMID: 39504595
DOI: 10.1016/j.ejso.2024.109349

Abstract

Background: Liver resection can induce complete remission after tumor downstaging in patients with locally advanced hepatocellular carcinoma. However, additional benefits of liver resection have not been investigated in patients expected to have complete pathological necrosis (CPN) following HCC downstaging.

Methods: Between 2002 and 2019, 999 patients with locally advanced HCC underwent concurrent chemoradiotherapy (CCRT) (n = 800) or transarterial radioembolization (TARE) (n = 199). Among these patients, excluding those who underwent liver transplantation, 94 who underwent liver resection (OP group) and 867 who did not undergo surgical treatment (non-OP group) were included in this study. CPN predictive factors in the OP group were analyzed using logistic regression analysis. Long-term outcomes were compared between patients with CPN (op-CPN) and those with CPN predictive factors in the non-OP group (nop-CPNPF).

Results: Of the 94 patients in the OP group, 38 (40.4 %) had CPN (CCRT, n = 72; TARE, n = 22). In the multivariate analysis, CPN predictive factors were complete radiologic response and tumor marker responders (odds ratio [OR] 18.468, p = 0.006; OR 3.698, p = 0.045). Among the non-OP group, 21 patients were in the nop-CPNPF group. There was no difference in DFS between the nop-CPNPF and op-CPN groups (40.0 ± 18.3 vs. 60.0 ± 14.0 months, p = 0.838). The OS of the op-CPN group was not higher than that of the nop-CPNPF group (5-year OS: 39.4 % vs. 33.3 %, p = 0.328).

Conclusions: The nop-CPNPF group showed long-term outcomes similar to those of the op-CPN group, suggesting that liver resection may not provide additional benefits for long-term outcomes in patients with CPN-PF after HCC downstaging.

Keywords: CCRT; HCC; Radiation therapy; Radioembolization.