Prognostic outcomes of surgery vs. non-surgery in initially unresectable HCC with successful conversion via ICI + TKI therapy

No consensus exists on optimal post-conversion therapy for initially unresectable hepatocellular carcinoma (uHCC) patients responding to a combination of immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs). This study evaluated surgical benefits and prognostic factors in such patients. Retrospective analysis of 67 uHCC patients receiving ICIs + TKIs conversion therapy. Log-rank test compared OS/PFS between surgical resection (SR, n = 30) and non-surgical (NSR, n = 37) groups; Cox regression identified prognostic factors. Baseline variables were balanced between groups. The SR group showed significantly higher PFS than the NSR group (P = 0.032), with 1-, 2-, and 3-year rates of 82.6%, 53.5%, and 31.2% versus 71.1%, 21.6%, and 14.4% for the NSR group. Partial response (PR) (HR = 6.0, P < 0.001) and AFP level ≥ 400 ng/ml (HR = 2.8, P = 0.021) emerged as independent prognostic factors associated with OS. For PFS, partial response (PR) (HR = 3.3, P = 0.002), number of tumors ≥ 3 (HR = 2.4, P = 0.020), and non-surgical treatment (HR = 2.2, P = 0.031) were relevant. Surgical intervention resulted in better PFS than non-surgical approaches, while no significant difference in OS was observed.