In HCC with macroscopic vascular invasion, hepatic resection was significantly linked with better overall survival after combined radiotherapy and transarterial chemoembolization.

Sang Min Yoon, MD, PhD

In patients with objective responses after combined radiotherapy (RT) and transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) with macroscopic vascular invasion (MVI), hepatic resection was significantly linked with better overall survival (OS).

Results of the study were presented at the 2023 American Society of Clinical Oncology (ASCO) annual meeting, held recently in Chicago.

Between 2010 and 2015, Sang Min Yoon, MD, PhD, and colleagues retrospectively assessed patients treated with combined RT and TACE as first-line therapy for HCC with MVI. Select patients with objective responses underwent liver transplantation or hepatic resection. The hepatobiliary and transplant surgeons for the multidisciplinary team for liver cancer determined if patients were candidates for surgical resection.

To enable researchers to examine the role of surgery, the control group consisted of patients with objective responses who did not undergo surgery. Utilizing a propensity score-based stabilized inverse probability of treatment weighting method to reduce selection bias, the survival outcomes between the patients who did not receive surgery and those who did were compared. The study team also conducted time-dependent survival analysis by surgery.

Patients in the Unweighted Surgery Group Were Younger

Among 170 patients with objective responses after combined RT and TACE, 41 had surgery, which included eight liver transplantations. The study authors observed that the unweighted surgery group was younger and had a higher proportion of unilateral vascular and solitary tumor involvement.

At 3 years, the OS rates were 61.0% and 28.6% in the surgery and non-surgery groups, respectively, after adjustment. Surgery was the key prognostic factor for OS (adjusted Cox proportional HR, 0.28; 95% CI, 0.17-0.46; P<0.001). Complete response following RT and TACE was also a key prognostic indicator for OS (adjusted HR, 0.41; 95% CI, 0.27-0.61; P<0.001). There was no mortality related to surgery; however, four patients (9.8%) needed additional surgery for graft failure or postoperative bleeding.