Prognostic Value of Clinical Complete Response for Patients with Initially Unresectable Hepatocellular Carcinoma after Conversion with Triple Therapy.

Introduction: Accurately predicting the outcomes of conversion therapy among patients with initially unresectable hepatocellular carcinoma (uHCC) remains a challenge. Clinical complete response (cCR) has been proposed as a predictor of prognosis. However, information on its prognostic value in these patients is limited. We aimed to explore the prognostic value of cCR in patients with uHCC following conversion therapy and identify predictors of cCR.

Methods: We included 241 patients with uHCC who underwent transcatheter arterial chemoembolization combined with lenvatinib and PD-1 inhibitors (triple therapy) as first-line treatment. The prognostic value of cCR, predictive factors of cCR, and the relationship between cCR and pathological complete response (pCR) were analyzed.

Results: The cCR rate of the 241 patients included was 17.4%. Patients with cCR showed better overall survival (OS) ( < 0.001) and progression-free survival (PFS) ( < 0.001) than those without. cCR was an independent risk factor for OS (hazard ratio [HR]: 0.11, 95% confidence interval [CI]: 0.03-0.42, = 0.001) and PFS (HR: 0.29, 95% CI: 0.15-0.56, < 0.001). Serum α-fetoprotein levels ≥400 ng/mL (odds ratio [OR]: 0.47, 95% CI: 0.22-0.95, = 0.040) and extrahepatic metastasis (OR: 0.13, 95% CI: 0.01-0.62, = 0.046) were independent negative predictors of cCR. A total of 107 patients (44.4%) underwent conversion surgery. Among these patients, cCR was associated with better OS ( = 0.009) and recurrence-free survival ( = 0.007). cCR was significantly correlated with pCR (Φ = 0.61, < 0.001). Albumin levels ≥35 g/L (OR: 0.12, 95% CI: 0.02-0.69, = 0.018) and cCR (OR: 30.32, 95% CI: 9.19-128.00, < 0.001) were independent predictors of pCR.

Conclusion: cCR after triple therapy has an excellent long-term survival advantage and is significantly related to pCR. cCR may be a surrogate marker for predicting prognosis and pCR in patients with uHCC receiving triple therapy.