CLINICAL complete response (cCR) is a strong predictor of prognosis in patients with unresectable hepatocellular carcinoma (uHCC) undergoing conversion therapy.
Accurately predicting outcomes for patients with initially unresectable hepatocellular carcinoma (uHCC) remains challenging. Clinical complete response (cCR) has been proposed as a potential prognostic marker, but its predictive value is not well established. This study aimed to assess the prognostic significance of cCR following conversion therapy and to identify key factors associated with achieving cCR.
A total of 241 patients with uHCC underwent transcatheter arterial chemoembolisation combined with lenvatinib and PD-1 inhibitors as first-line treatment. Among them, 17.4% achieved cCR. Patients with cCR demonstrated significantly improved overall survival (OS) (p<0.001) and progression-free survival (PFS) (p<0.001) compared to those without. cCR was an independent predictor of OS (HR: 0.11, 95% CI: 0.03–0.42, p=0.001) and PFS (HR: 0.29, 95% CI: 0.15–0.56, p<0.001). High serum α-fetoprotein levels (≥400 ng/mL, OR: 0.47, p = 0.040) and extrahepatic metastasis (OR: 0.13, p=0.046) were significant negative predictors of cCR. Among 107 patients who underwent conversion surgery, those with cCR had superior OS (p = 0.009) and recurrence-free survival (p=0.007). Additionally, cCR was strongly correlated with pathological complete response (pCR) (Φ: 61, p<0.001), and albumin levels ≥35 g/L (OR: 0.12, p=0.018) alongside cCR (OR: 30.32, p<0.001) were independent predictors of pCR.
These findings suggest that cCR following triple therapy is associated with substantial long-term survival benefits and is a strong indicator of pCR. Given its prognostic value, cCR may serve as a surrogate marker for treatment response in clinical practice, aiding in patient stratification and therapeutic decision-making. Future studies should focus on optimising treatment strategies to enhance cCR rates and improve patient outcomes.
Katheeja Imani, EMJ
Reference
Wu JY et al. Prognostic value of clinical complete response for patients with initially unresectable hepatocellular carcinoma after conversion with triple therapy. Liver Cancer. 2025;1-24.
