Survival benefits and prognostic models of surgical resection versus continued medical treatment in CNLC stage IIb/IIIa hepatocellular carcinoma after meeting resectability criteria following conversion therapy
- 1Department of Hepatobiliary, Pancreatic, and Transplantation Surgery, The First Affiliated Hospital of Anhui Medical University
Abstract
Objective: The combination of targeted therapy, immunotherapy, and locoregional treatment has established conversion therapy as a viable strategy for China Liver Cancer Staging (CNLC) stage IIb/IIIa hepatocellular carcinoma (HCC). However, upon meeting the criteria for tumor resectability after successful conversion, it remains controversial whether surgical resection (SR) provides superior survival benefits compared to continued medical treatment (CMT), and the optimal timing for surgery is still undefined.
Methods: We retrospectively analyzed 363 CNLC stage IIb/IIIa HCC patients who met strict tumor resectability criteria after a conversion regimen of lenvatinib, anti-PD-1 antibodies, and transarterial chemoembolization (TACE). Patients were randomly assigned to a training cohort (n = 255) and an internal validation cohort (n = 108) at a 7:3 ratio. Propensity score matching (PSM) was utilized to balance the baseline characteristics. Survival outcomes were compared and prognostic nomograms were developed using Cox proportional hazards regression.
Results: After 1:3 PSM, the training cohort comprised 63 SR patients and 189 CMT patients. The SR group demonstrated significantly better median overall survival (mOS, 32.1 vs. 24.3 months; P < 0.0001) and median progression-free survival (mPFS, 15.3 vs. 10.6 months; P = 0.0041) than the CMT group. The prognostic nomograms developed for both groups exhibited excellent discrimination via bootstrap resampling and in the internal validation cohort. Restricted cubic spline (RCS) and Kaplan-Meier analyses revealed that an interval > 90 days from meeting resectability criteria to surgery, and a pre-operative AFP to baseline AFP (at the time resectability was met) ratio > 1, were significantly associated with worse OS.
Conclusion: For CNLC stage IIb/IIIa HCC patients achieving tumor resectability following conversion therapy, SR is significantly associated with improved survival outcomes compared to CMT. Based on our exploratory findings, surgery within 90 days of meeting resectability criteria may be considered a beneficial strategy, provided that the pre-operative AFP level does not exceed the level observed when resectability was initially achieved.
Related
- Resection rates after conversion therapy for initially unresectable hepatocellular carcinoma: a systematic review and meta-analysis
- A Contemporary Review of Resectability and Treatment Strategies for Colorectal Liver Metastases: Part 2-Advanced Surgical Techniques, Conversion Strategies, and the Expanding Boundaries of Treatment.
- Peri-interventional neutrophil extracellular traps and immune surveillance in hepatocellular carcinoma: mechanisms, biomarkers, and recurrence after liver resection or thermal ablation
- Association of steatotic liver disease with long-term oncological outcomes after hepatic resection for hepatocellular carcinoma
- Preoperative Zinc Deficiency as a Novel Prognostic Predictor for Postoperative Recurrence in Hepatocellular Carcinoma
BibTeX
@article{qiu2026survival,
title = {{Survival benefits and prognostic models of surgical resection versus continued medical treatment in CNLC stage IIb/IIIa hepatocellular carcinoma after meeting resectability criteria following conversion therapy}},
author = {Jian Qiu and Zhenghui Ye and Liyang Zhao and Wei Liu and Shenao Liu and Hongchuan Zhao},
journal = {Frontiers in Oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1958780},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1958780/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Survival benefits and prognostic models of surgical resection versus continued medical treatment in CNLC stage IIb/IIIa hepatocellular carcinoma after meeting resectability criteria following conversion therapy
AU - Jian Qiu
AU - Zhenghui Ye
AU - Liyang Zhao
AU - Wei Liu
AU - Shenao Liu
AU - Hongchuan Zhao
PY - 2026
DA - 2026/10/14
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1958780
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1958780/full
AB - Objective: The combination of targeted therapy, immunotherapy, and locoregional treatment has established conversion therapy as a viable strategy for China Liver Cancer Staging (CNLC) stage IIb/IIIa hepatocellular carcinoma (HCC). However, upon meeting the criteria for tumor resectability after successful conversion, it remains controversial whether surgical resection (SR) provides superior survival benefits compared to continued medical treatment (CMT), and the optimal timing for surgery is still undefined. Methods: We retrospectively analyzed 363 CNLC stage IIb/IIIa HCC patients who met strict tumor resectability criteria after a conversion regimen of lenvatinib, anti-PD-1 antibodies, and transarterial chemoembolization (TACE). Patients were randomly assigned to a training cohort (n = 255) and an internal validation cohort (n = 108) at a 7:3 ratio. Propensity score matching (PSM) was utilized to balance the baseline characteristics. Survival outcomes were compared and prognostic nomograms were developed using Cox proportional hazards regression. Results: After 1:3 PSM, the training cohort comprised 63 SR patients and 189 CMT patients. The SR group demonstrated significantly better median overall survival (mOS, 32.1 vs. 24.3 months; P < 0.0001) and median progression-free survival (mPFS, 15.3 vs. 10.6 months; P = 0.0041) than the CMT group. The prognostic nomograms developed for both groups exhibited excellent discrimination via bootstrap resampling and in the internal validation cohort. Restricted cubic spline (RCS) and Kaplan-Meier analyses revealed that an interval > 90 days from meeting resectability criteria to surgery, and a pre-operative AFP to baseline AFP (at the time resectability was met) ratio > 1, were significantly associated with worse OS. Conclusion: For CNLC stage IIb/IIIa HCC patients achieving tumor resectability following conversion therapy, SR is significantly associated with improved survival outcomes compared to CMT. Based on our exploratory findings, surgery within 90 days of meeting resectability criteria may be considered a beneficial strategy, provided that the pre-operative AFP level does not exceed the level observed when resectability was initially achieved.
SN - 2234-943X
ER -