ORIGINAL RESEARCH article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1704239
Tumor Regression Grade Predicts Recurrence-Free Survival in Intermediate-Advanced Hepatocellular Carcinoma After Conversion Therapy
Provisionally accepted
- 1West China Hospital of Sichuan University, Chengdu, China
- 2Sichuan Cancer Hospital and Institute, Chengdu, China
- 3Sichuan University, Chengdu, China
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Background: Conversion therapy provides patients with intermediate-advanced hepatocellular carcinoma (HCC) an opportunity for radical resection, but the prognostic significance of residual tumor in resected specimens remains unclear. This study aimed to evaluate the impact of pathological tumor regression grade (TRG) on postoperative recurrence in HCC patients who underwent conversion therapy. Methods: Data from HCC patients who received conversion therapy between September 2018 and September 2022 were retrospectively collected. Patients were categorized based on TRG status: TRG1a, TRG1b, TRG2, and TRG3. Multivariate regression analyses were performed to identify independent predictors of recurrence and factors associated with optimal TRG status after resection. Results: A total of 117 patients who underwent conversion resection were enrolled. Multivariate regression analysis revealed that achieving TRG1b was not significantly associated with recurrence, whereas TRG2 (HR = 4.25, P = 0.012) and TRG3 (HR = 6.20, P < 0.001) were independently associated with an increased risk of postoperative recurrence compared to TRG1a. The combined TRG1(a&b) group demonstrated significantly longer recurrence-free survival (RFS) compared to the TRG2 (P = 0.0075) and TRG3 (P < 0.001) groups, respectively. Independent predictors for achieving TRG1(a&b) included male gender (OR = 3.44, P < 0.001), treatment with TACE combined with targeted therapy and immunotherapy (P < 0.001), pre-treatment tumor diameter of 5-10 cm (OR = 2.31, P = 0.012), and rapid normalization of AFP levels (OR = 0.97, P < 0.001). Conclusions: Achieving TRG1 status (0-10% residual tumor) following conversion therapy is associated with significantly improved RFS in patients with intermediate-advanced HCC. Male patients, tumors measuring 5 - 10 cm, combined TACE with systemic therapies, and rapid normalization of AFP levels are significant predictors for achieving TRG1 status.
Keywords: Hepatocellular Carcinoma, Conversion therapy, tumor regression grade, Recurrence-free survival, prediction
Received: 12 Sep 2025; Accepted: 20 Oct 2025.
Copyright: © 2025 Zhang, Yang, Huang, Li, Xu and Wei. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Hongwei Xu, xuhongwei@wchscu.edu.cn
Yonggang Wei, weiyonggang@wchscu.edu.cn
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