Resection rates after conversion therapy for initially unresectable hepatocellular carcinoma: a systematic review and meta-analysis
5 affiliations
- 1Department of Gastroenterology, People’s Hospital of Chongqing Hechuan , ,
- 2Department of Hepatobiliary Surgery, People’s Hospital of Chongqing Hechuan , ,
- 3Department of General Practice, People’s Hospital of Chongqing Hechuan , ,
- 4Department of Obstetrics, The Affiliated Banan Hospital of Chongqing Medical University (People’s Hospital of Banan District) , ,
- 5Department of Hepatobiliary Surgery, Shapingba Hospital Affiliated to Chongqing University (Shapingba District People’s Hospital of Chongqing) , ,
Abstract
Introduction: Conversion therapy may create an opportunity for liver resection in selected patients with initially unresectable hepatocellular carcinoma (HCC), but reported conversion rates use heterogeneous denominators and endpoints. We estimated actual completed hepatectomy using a verified all-treated denominator.
Methods: PubMed/MEDLINE, Embase, Web of Science Core Collection, Cochrane Library/CENTRAL, Wanfang Data, and CNKI were searched through April 10, 2026. Eligible cohorts included initially or baseline unresectable HCC, an all-treated denominator, and completed liver resection events. Two authors independently assessed eligibility, extracted data, and evaluated risk of bias. Random-effects logit proportion meta-analysis, Hartung-Knapp sensitivity, prediction intervals, leave-one-out analyses, treatment-strategy subgroups, publication-year meta-regression, and small-study-effect diagnostics were undertaken. PROSPERO: CRD420261360108.
Results: Thirty-seven reports represented 36 unique studies; 34 studies involving 5,137 patients and 1,042 completed hepatectomies entered the quantitative synthesis. The crude aggregate resection rate was 20.3% (1,042/5,137), whereas the random-effects modeled pooled rate was 25.40% (95% CI, 20.74%-30.69%; I ² =91.5%; tau ² =0.5132). The Hartung-Knapp 95% CI was 20.12%-31.51%, and the prediction interval was 7.16%-60.04%. Leave-one-out estimates ranged from 24.52% to 26.64%. Treatment-strategy differences were not statistically significant (Qm=5.17, df=2, P = 0.075). Publication-year meta-regression did not show a clear linear association (OR per decade 1.19, 95% CI 0.77-1.83; P = 0.440), and Egger’s test did not indicate significant funnel asymmetry (P = 0.381).
Conclusions: Approximately one-quarter of patients initiating conversion therapy underwent actual hepatectomy, but the crude and modeled estimates differ because substantial heterogeneity changes random-effects study weighting. The pooled estimate is a cross-study, cross-era benchmark for multidisciplinary decision-making rather than a universal patient-level probability or a treatment-specific efficacy estimate.
Systematic Review Registration: www.crd.york.ac.uk/prospero/ , identifier CRD420261360108.
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BibTeX
@article{ouyang2026resection,
title = {{Resection rates after conversion therapy for initially unresectable hepatocellular carcinoma: a systematic review and meta-analysis}},
author = {Xiaobo Ouyang and Ji Li and Po Liang and Yanfei Wang and Yangming Liu and Zhuoren Cheng and Ping Che},
journal = {Frontiers in oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1898480},
url = {https://europepmc.org/article/PMC/PMC13668533},
note = {CC BY},
}
RIS
TY - JOUR
TI - Resection rates after conversion therapy for initially unresectable hepatocellular carcinoma: a systematic review and meta-analysis
AU - Xiaobo Ouyang
AU - Ji Li
AU - Po Liang
AU - Yanfei Wang
AU - Yangming Liu
AU - Zhuoren Cheng
AU - Ping Che
PY - 2026
DA - 2026/10/01
JO - Frontiers in oncology
DO - 10.3389/fonc.2026.1898480
UR - https://europepmc.org/article/PMC/PMC13668533
AB - Introduction: Conversion therapy may create an opportunity for liver resection in selected patients with initially unresectable hepatocellular carcinoma (HCC), but reported conversion rates use heterogeneous denominators and endpoints. We estimated actual completed hepatectomy using a verified all-treated denominator. Methods: PubMed/MEDLINE, Embase, Web of Science Core Collection, Cochrane Library/CENTRAL, Wanfang Data, and CNKI were searched through April 10, 2026. Eligible cohorts included initially or baseline unresectable HCC, an all-treated denominator, and completed liver resection events. Two authors independently assessed eligibility, extracted data, and evaluated risk of bias. Random-effects logit proportion meta-analysis, Hartung-Knapp sensitivity, prediction intervals, leave-one-out analyses, treatment-strategy subgroups, publication-year meta-regression, and small-study-effect diagnostics were undertaken. PROSPERO: CRD420261360108. Results: Thirty-seven reports represented 36 unique studies; 34 studies involving 5,137 patients and 1,042 completed hepatectomies entered the quantitative synthesis. The crude aggregate resection rate was 20.3% (1,042/5,137), whereas the random-effects modeled pooled rate was 25.40% (95% CI, 20.74%-30.69%; I ² =91.5%; tau ² =0.5132). The Hartung-Knapp 95% CI was 20.12%-31.51%, and the prediction interval was 7.16%-60.04%. Leave-one-out estimates ranged from 24.52% to 26.64%. Treatment-strategy differences were not statistically significant (Qm=5.17, df=2, P = 0.075). Publication-year meta-regression did not show a clear linear association (OR per decade 1.19, 95% CI 0.77-1.83; P = 0.440), and Egger’s test did not indicate significant funnel asymmetry (P = 0.381). Conclusions: Approximately one-quarter of patients initiating conversion therapy underwent actual hepatectomy, but the crude and modeled estimates differ because substantial heterogeneity changes random-effects study weighting. The pooled estimate is a cross-study, cross-era benchmark for multidisciplinary decision-making rather than a universal patient-level probability or a treatment-specific efficacy estimate. Systematic Review Registration: www.crd.york.ac.uk/prospero/ , identifier CRD420261360108.
SN - 2234-943X
ER -