Downstaging Therapy Can Enable HCC Resection

Successful downstaging may help identify patients with unresectable hepatocellular carcinoma (HCC) who could benefit from hepatic resection, according to a systematic review and meta-analysis published in the journal Frontiers in Oncology.

“HCC is a high-grade malignant disease with unfavorable prognosis, and although surgical therapy is necessary, not all patients with HCC are suitable candidates for surgery,” wrote a research team based in China. “Downstaging as preoperative therapeutic strategy, which can convert unresectable HCC into resectable HCC, intends to increase the resection rate and improve prognosis.”

The meta-analysis included 20 studies that investigated systemic treatment, transcatheter arterial chemoembolization, yttrium 90 microsphere selective internal radiation/transcatheter radioembolization, and hepatic arterial infusion as downstaging therapies aimed at shrinking tumors before resection for patients with unresectable HCC.

The pooled downstaging rate of hepatic resection was 14%, according to the study.

Overall survival was significantly better among patients who received resection after downstaging compared with locoregional therapy or systemic treatment alone, an analysis of comparative studies showed. The relative risks of overall survival after downstaging and resection were 1.87 at 1 year, 5.56 at 3 years, and 5.47 at 5 years.

Pooled disease-free survival rates in patients undergoing hepatic resection after successful downstaging were 78% at 1 year, 47% at 3 years, and 46% at 5 years. Pooled overall survival rates were 88% at 1 year, 64% at 3 years, and 42% at 5 years, researchers reported.

“Based on this meta-analysis, operable patients with unresectable HCC may be screened for downstaging,” the authors concluded. “Surgical resection after successful downstaging can maximize the improvements in the prognosis of patients with unresectable HCC, bringing hope for patients initially considered incurable.”

—Jolynn Tumolo

Reference:

Chen X, Lai L, Ye J, Li L. Downstaging therapies for unresectable hepatocellular carcinoma prior to hepatic resection: a systematic review and meta-analysis. Front Oncol. 2021;11:740762. doi:10.3389/fonc.2021.740762