Stable Disease without Tumor Shrink Cannot Benefit from Surgery following Immune-Based Therapy in Potentially Resectable Hepatocellular Carcinoma

Background: The criteria for identifying patients with potentially resectable hepatocellular carcinoma (HCC) at the baseline stage have helped identify patients who are more likely to achieve successful conversion. However, the suitable timing and selection of candidates for conversion surgery after systemic therapy remained underexplored. Methods: Based on real-world evidence, we analyzed a cohort of 222 patients with potentially resectable HCC treated with immune-based therapy between January 2019 and May 2024. The treatment response was assessed using the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1) and modified RECIST (mRECIST). Depth of response (DpR) was defined as the maximum tumor shrinkage from baseline, based on the sum of the longest diameters, as assessed by an independent review facility per RECIST v1.1. Conversely, stable disease (SD) with a DpR < 0%/> 0% was categorized as SD_shrink/SD_non-shrink. Survival outcomes were compared between patients who underwent surgery and those who did not, with different DpRs, and assessed using Kaplan-Meier methods. Results: = 0.004, respectively), whereas the survival of patients who did not undergo surgery did not differ. Conclusion: DpR is an important factor in choosing the right candidates and the timing of conversion therapy. Patients only at a DpR