Survival outcomes after surgical resection of huge HCC (≥ 10 cm) with or without neoadjuvant hepatic arterial infusion chemotherapy

TL;DR

This study shows that a new chemotherapy regimen before surgery can reduce early recurrence and improve survival in patients with large liver cancer.

Contribution

A new HAIC regimen is shown to reduce early recurrence and improve survival outcomes in huge HCC patients undergoing surgery.

Findings

Neoadjuvant HAIC reduced early tumor recurrence in huge HCC patients.

The HAIC group had significantly longer disease-free survival compared to the surgery-only group.

Patients with recurrence after 12 months had better survival outcomes in the HAIC group.

Abstract

To evaluate the survival outcomes of huge HCC (tumor size ≥ 10 cm) after surgical resection (SR) with or without neoadjuvant hepatic arterial infusion chemotherapy (HAIC).

119 huge HCC patients underwent SR in our Hospital (2010–2020). A new HAIC regimen (cisplatin, leucovorin, mitomycin-C and 5-FU infusion for 5 days plus 10 ml lipiodol microvascular embolization) was adopted as the neoadjuvant therapy in 25 patients. Treatment responses were evaluated based on mRECIST criteria. The objective response rate (ORR), disease free survival (DFS), recurrence survival (RS) and overall survival (OS) were compared between the SR-only and neoadjuvant HAIC groups.

Of the 119 patients, 65 patients were Vp2, 9 patients were Vp3 and 4 patients were Vp4. In the subgroup analysis, neoadjuvant HAIC group revealed significantly more severe clinical status. Of the neoadjuvant HAIC patients, ORR was 66.7%. Postoperative tumor recurrence was noted in 75% and 58.3% of the SR and neoadjuvant groups, of them 56.5% and 20.8% developed in ≤ 12 months. The median DFS, RS and OS in each group were 10 vs. 41 months (p = 0.016), 36 vs. 91 months and 46 vs. 96 months, respectively. Subgroup analysis revealed no significant survival difference of the RS in both patient groups with tumor recurrence ≤ 12 months (17 vs. 14 months) or > 12 months/without recurrence (not reached vs. 113 months).

Our new regimen HAIC acted as an effective neoadjuvant therapy in reducing early recurrence rate and prolonged DFS of huge HCC after surgical resection.

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