Anatomic Versus Nonanatomic Liver Resection After Conversion Therapy for Hepatocellular Carcinoma

Patients with initially unresectable HCC who underwent liver resection after successful immune checkpoint inhibitor-based conversion therapy conversion therapy at the Sun Yat-sen University Cancer Center (SYSUCC)

Inclusion Criteria:

• Clinical diagnosis of initially unresectable HCC
• Received conversion therapy based on PD-1/PD-L1 therapy.
• Two liver surgeons with associate senior or higher professional titles determine that R0 resection is feasible after conversion therapy.
• Child-Pugh class A liver function.
• ECOG performance status 0 or 1.
• Adequate organ and bone marrow function, based on laboratory tests within 7 days before enrollment: ANC ≥1.5 × 10^9/L; platelet count ≥75 × 10^9/L; hemoglobin ≥9.0 g/dL; total bilirubin ≤1.5 × ULN; ALT, AST, and ALP ≤3 × ULN; serum albumin ≥28 g/L; serum creatinine ≤1.5 × ULN or creatinine clearance ≥50 mL/min by Cockcroft-Gault; urine protein <2+, or, if ≥2+ at baseline, 24-hour urine protein <1 g; INR and APTT ≤1.5 × ULN; TSH between the lower and upper limits of normal (if abnormal, FT3 and FT4 must be normal).

Exclusion Criteria:

• Any cancer treatment other than conversion therapy.
• Any of the following within 12 months before study start: myocardial infarction, severe/unstable angina, coronary artery bypass grafting, congestive heart failure, cerebrovascular accident (including transient ischemic attack), or pulmonary embolism; ongoing arrhythmia of CTCAE Grade 2 or higher; or QTc >450 ms in men or >470 ms in women.
• Renal insufficiency requiring peritoneal dialysis or hemodialysis.
• Severe dysfunction of another major organ.
• Prior diagnosis of a second primary malignancy.
• Known or new evidence of brain or leptomeningeal disease.
• Hemophilia or bleeding tendency, or therapeutic anticoagulation with coumarin derivatives.
• Prior organ transplantation.