Curative Surgery After Immunotherapy Reduces Death Risk by 85% in Advanced Liver Cancer
Key Insights
Patients with advanced hepatocellular carcinoma (search) who underwent curative surgery after immunotherapy (search) showed an 85% reduction in death risk compared to those receiving immunotherapy alone.
Only 3.2% of liver cancer (search) patients received curative treatment conversion after immunotherapy (search), despite significant survival benefits across all surgical approaches including resection, transplantation, and ablation.
The study analyzed data from 4,765 patients and found that academic medical centers were more likely to offer curative treatment conversion, suggesting underutilization of this life-extending approach.
Patients with advanced hepatocellular carcinoma (search) (HCC) who undergo curative surgery following immunotherapy (search) experience dramatically improved survival outcomes, with an 85% reduction in death risk compared to those who continue immunotherapy alone, according to a comprehensive analysis of more than 4,700 patients published in Liver Cancer (search).
The study, led by specialists from Cedars-Sinai Cancer (search), examined data from the US National Cancer Database (search) on 4,765 patients with HCC who received frontline immunotherapy (search) between 2017 and 2020. Despite the substantial survival benefits, only 3.2% of patients (138 individuals) received curative treatment conversion (CTC) after immunotherapy, representing what researchers describe as a significant missed opportunity.
Surgical Approaches Show Consistent Benefits
Among the 138 patients who underwent curative treatment conversion, surgical resection was the most common approach at 54.3% (75 patients), followed by local ablation at 25.4% (35 patients) and liver transplantation at 20.3% (28 patients). All three approaches demonstrated significant survival improvements, with resection showing the highest survival probabilities, followed by transplantation and local ablation.
The multivariate analysis revealed that curative treatment conversion independently correlated with better overall survival outcomes (HR, 0.20; 95% CI, 0.11-0.37; P <.001). Specifically, ablation (HR, 0.21; 95% CI, 0.05-0.86; P = .03), resection (HR, 0.18; 95% CI, 0.08-0.40; P <.001), and liver transplantation (HR, 0.28; 95% CI, 0.09-0.87; P = .03) were all independently associated with improved survival.
Patient Characteristics and Treatment Patterns
The study population had a median age of 66 years, with 81% being male. The most common disease stages were T4 (33%), followed by M1 (32%) and N1 (22%) according to AJCC criteria. Patients experienced a median of 3.0 months from immunotherapy (search) initiation to curative treatment.
Patients who received curative treatment conversion differed significantly from those who did not. They were younger (median age 63 years vs 66 years; P = .004) and had smaller tumors (median size 57 mm vs 75 mm; P = .002). Notably, 78% of CTC patients received care at academic health facilities compared to 48% of non-CTC patients (P <.001).
Academic Centers Drive Treatment Access
The analysis revealed that treatment at an academic center independently correlated with better overall survival outcomes (HR, 0.70; 95% CI, 0.59-0.82; P <.001). Multivariate logistic regression showed that factors associated with receiving curative treatment after immunotherapy (search) included the absence of node metastases (OR, 0.16; 95% CI, 0.02-0.56; P = .02) and treatment at an academic health center (OR, 3.40; 95% CI, 1.68-7.38; P = .001).
"The data we reviewed showed that patients who received follow-up transplants or tumor removal after immunotherapy (search) reduced the size of their tumors lived much longer than patients who just remained on immunotherapy," stated Dr. Ju Dong Yang, medical director of the Liver Cancer (search) Program at Cedars-Sinai and senior study author. "Performing liver transplant following immunotherapy isn't yet common practice."
Clinical Implications and Missed Opportunities
The researchers emphasized that many patients die not from the tumor itself, but from associated liver diseases that transplantation could eliminate. Dr. Yang noted that this represents a significant missed opportunity, as patients with advanced liver cancer (search) often die without curative treatment even when their cancer is under control.
In propensity score-matched analyses of 138 pairs between CTC and non-CTC populations, curative treatment conversion correlated with significantly longer overall survival (HR, 0.22; 95% CI, 0.14-0.33; P <.001). Additional matching analyses confirmed improved outcomes with resection (HR, 0.05; 95% CI, 0.02-0.11; P <.001), local ablation (HR, 0.19; 95% CI, 0.09-0.38; P <.001), and transplantation (HR, 0.16; 95% CI, 0.07-0.36; P <.001).
"When our physician-scientists create studies based on patient needs and then apply their findings to patient care, it improves outcomes for everyone we serve and for patients around the world," said Dr. Robert Figlin, interim director of Cedars-Sinai Cancer (search). "As an academic medical center, that is our mission."