关键词: 原发性肝癌, 初始不可切除, 转化治疗, 肝切除术

Abstract: Objective To evaluate the clinical efficacy and clinical features of sequential surgical resection of unresectable hepatocellular carcinoma after conversion therapy. Methods Clinical data of 13 patients with initial unresectable liver cancer admitted to Nanfang Hospital of Southern Medical University from January 2020 to December 2021 were retrospectively analyzed. Results Of the 13 patients, 12 were male and 1 was female, aged 50.0±12.7 years （range:23-72 years）; The child-Pugh grades were all A; CNLC Stage:5 patients with Stage Ⅰb, 2 patients with Stage Ⅱa, 2 patients with Stage Ⅱb, 3 patients with Stage Ⅲa, and 1 patient with Stage Ⅲb; ECOG PS score ≤1; There were 6 cases with cirrhosis and 7 cases without cirrhosis; There were 2 cases with portal vein tumor thrombosisand 11 cases without. The maximum tumor diameter before treatment was 9.8±2.7 cm, and the median AFP was 848.1 ng/mL （IQR:20.0-4638.1 ng/mL）. There were 12 cases with hepatitis B and 1 case without hepatitis B. Conversion treatment programme:TACE combined with Immune checkpoint inhibitors in 2 cases, TACE combined with Anti-angiogenic targeting drugs and Immune checkpoint inhibitors and in 6 cases, HAIC combined with Anti-angiogenic targeting drugs and Immune checkpoint inhibitors in 3 cases, and TACE combined with HAIC and Anti-angiogenic targeting drugs and Immune checkpoint inhibitors in 2 cases.The median conversion time was 3.4 months （IQR:2.7~5.5 months）, the maximum tumor diameter before conversion therapy was 7.1±2.2 cm, and the median AFP level before conversion therapy was 17.2 ng/mL （IQR:4.0~121.6 ng/mL）, preoperative imaging assessment （mRECIST） of CR in 2 cases, PR in 5 cases, PD in 1 case, SD in 5 cases, and there were 7 cases of conversion in oncology and 6 cases of conversion in surgery, preoperative PS score ≤1 point. After therapy, surgical resection was performed:10 cases underwent partial hepatectomy, 3 cases underwent semi-hepatic resection, 6 cases underwent laparoscopic surgery, and 7 cases underwent laparotomy. The median operative time was 295.0 min （IQR:230.5~418.0 min）, the median intraoperative blood loss was 300 mL （IQR:100~375 mL）, the median postoperative hospital stay was 10 days （IQR:7 ~ 13 days）, and the median postoperative drainage tube removal time was 7 days （IQR:5.5~13 days）. Postoperative pathological results:pCR 6 cases, pPR 7 cases, MVI grade M0 10 cases, M1 3 cases, all <5 intravascular cancer thrombi, including 2 cases of 1 intravascular cancer thrombi, no resection margin positive case. Postoperative heart failure occurred in 1 case, pulmonary embolism occurred in 1 case and bile leakage occurred in 1 case. The median postoperative follow-up time was 11.9 months （IQR:6.3~15.1 months）, and 3 patients had a recurrence, and no patient died during follow-up. Conclusion Sequential resection of primary unresectable hepatocellular carcinoma following conversion therapy is effective and safe.

Key words: hepatocellular carcinoma, initial unresectable, conversion therapy, hepatectomy