To evaluate clinical efficacy of surgical resection after targeted immunotherapy in patients with initially unresectable hepatocellular carcinoma (HCC).

Clinical data of 5 patients with intermediate-stage and advanced unresectable HCC admitted to Nantong Third People's Hospital Affiliated to Nantong University from January 2021 to October 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 4 patients were male and 1 female, aged from 50 to 63 years, with a median age of 57 years. According to the China liver cancer (CNLC) staging system, 1 case was classified asCNLC-Ⅲa, 1 case as CNLC-Ⅲb, and 3 cases as CNLC-Ⅱb. Surgical resection was performed after treating with lenvatinib combined with tislelizumab in patients with initially unresectable HCC. Surgical methods, postoperative complications, tumor necrosis rate and prognosis were analyzed.

A total of3-8 cycles of targeted immunotherapy were delivered. During the treatment, all patients were stable and tolerant, presenting with grade 1-2 adverse reactions and no significant discomfort. Definite clinical efficacy was achieved. Partial remission (PR) or complete remission (CR) of the tumors was obtained. Expected surgical indications were achieved. All 5 patients successfully received conversion therapy followed by surgical resection, including 1 case of left hepatectomy, 1 case of right hepatectomy and 3 cases of partial hepatectomy, respectively. The tumor necrosis rates were 100%, 30%, 85%, 60% and 70%, respectively. Negative surgical margins were observed in 4 cases. The follow-up time was ranged from 4 to 20 months,with a median time of 16 months. During postoperative follow-up, no recurrence was reported,5 patients were physically stable and no patient died.

Targeted immunotherapy is safe and efficacious for patients with initially unresectable HCC. Conversion therapy may achieve radical resection and prolong the survival of patients.