Analysis Of Factors Affecting The Surgical Conversion Rate Of Unresectable Hepatocellular Carcinoma With HAIC Combined With Targeted And Immunotherapy

Purpose:Unresectable hepatocellular carcinoma(HCC)accounts for 60%-70%of initially diagnosed HCC in China and has a poor prognosis.Guided by the concept of total integrated management,hepatic artery infusion chemotherapy(HAIC)combined with tyrosine kinase inhibitors(TKIs)and programmed cell death protein-1(PD-1)inhibitors has shown good anti-tumor effects in the treatment of unresectable HCC,but we have observed in our clinic that the surgical conversion rate is still low,and the specific reasons for this need further investigation.The aim of this study was to investigate the risk factors of HAIC combined with targeted and immunotherapy affecting the surgical conversion rate of unresectable HCC.Methods:This study included 155 patients with initial unresectable HCC between June 2020 and June 2022 who received at least one cycle of HAIC combined with targeted and immunotherapy.Risk factors affecting surgical conversion rate were analyzed byχ~2test in univariate analysis and logistic regression analysis in multivariate analysis.Results:A total of 155 patients were included in this study,of which 27 patients achieved surgical conversion,with a surgical conversion rate of 17.4%(27/155).Univariate analysis showed that patients’age,gender,history of hepatitis B,ECOG PS score,Child-Pugh classification,albumin,glutamate transaminase,glutathione transaminase,gamma glutamyl transferase,alkaline phosphatase,prothrombin time,alpha-fetoprotein(AFP)level,maximum tumor diameter,absence or presence of vascular invasion,absence or presence of extrahepatic metastases,BCLC stage,AJCC stage,CNLC stage,HAIC regimen,number of HAIC treatments,TKIs regimen,PD-1 inhibitor regimen were not significantly correlated with surgical conversion rate and the difference was not statistically significant(P>0.05),while whether patients had combined cirrhosis,total bilirubin,ALBI classification,tumor location,and tumor number were significantly correlated with surgical conversion rate of unresectable HCC patients and the difference was statistically significant(P<0.05).Multi-factor logistic regression analysis showed that total bilirubin>17.1μmol/L,tumor located in both lobes,and multiple tumor numbers were independent risk factors affecting the surgical conversion rate in patients with unresectable HCC.Conclusions:Whether the patients were combined with cirrhosis,total bilirubin,ALBI classification,tumor location,and tumor number were significantly correlated with the surgical conversion rate of patients with unresectable HCC.Patients with total bilirubin>17.1μmol/L,tumors located in both lobes,and the number of tumors being multiple were independent risk factors affecting the surgical conversion rate of unresectable HCC.