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

摘要： 目的 评估初始不可切除肝癌经转化治疗后行序贯手术切除的临床疗效和分析其临床特征。方法 回顾性收集并分析南方医科大学南方医院2020年1月至2021年12月期间收治的13例初始不可切除肝癌患者的临床数据。结果 13例患者中,12例为男性患者,1例为女性患者,年龄50.0±12.7岁（23~72岁）;Child-Pugh分级标准均为A级;CNLC Stage分级Ib期5例,Ⅱa期2例,Ⅱb期2例,Ⅲa期3例,Ⅲb期1例;ECOG ps评分均≤1分;肝硬化者有6例,无肝硬化者7例;有门脉癌栓者2例,无门脉癌栓者11例;治疗前最大肿瘤直径9.8±2.7 cm,治疗前中位AFP为848.1 ng/mL（IQR：20.0~4638.1 ng/mL）;有乙肝者12例,无乙肝者1例。转化治疗方案：TACE+免疫方案治疗的有2例、TACE+靶向+免疫方案治疗的有6例、HAIC+靶向+免疫方案3例及TACE+HAIC+靶向+免疫方案治疗的2例。中位转化时间为3.4月（IQR：2.7~5.5月）,转化治疗后术前的肿瘤最大直径为7.1±2.2 cm,转化治疗后术前的中位AFP水平17.2 ng/mL（IQR：4.0~121.6 ng/mL）,术前影像学评估（mRECIST）CR 2例,PR 5例,PD 1例,SD 5例,肿瘤学转化7例,外科学转化6例,术前PS评分均≤1分。转化后行手术切除：10例行肝部分切除,3例行半肝切除,经腹腔镜手术6例,开腹手术7例。中位手术时间295.0 min（IQR：230.5~418.0 min）,中位术中出血量300 mL（IQR：100~375 mL）,术后中位住院天数为10 d（IQR：7~13 d）,术后中位拔除引流管的时间为7 d（IQR：5.5~13 d）。术后病理结果pCR 6例,pPR有7例,MVI分级M0 10例,M1有3例,均为<5处脉管内癌栓,其中2例为1处脉管内癌栓,无一例切缘阳性病例。术后出现心衰1例,术后出现肺动脉栓塞1例,术后出现胆漏1例。术后中位随访时间11.9月（IQR：6.3~15.1月）,3位患者出现复发,随访期间无一例患者死亡。结论 转化后行序贯手术切除的临床疗效效果肯定,安全性尚可。

关键词: 原发性肝癌, 初始不可切除, 转化治疗, 肝切除术