To investigate the influencing factors of outcome of conversion therapy of initially unresectable hepatocellular cancer (iuHCC) to provide evidence for individualized treatment strategies.

This study was a retrospective case-control study that involved 142 patients with iuHCC, including 39 patients with iuHCC who underwent systemic treatment and achieved conversion success at the Affiliated Li Huili Hospital of Ningbo University from January 2018 to August 2022, and 103 patients with failed conversion therapy during the same period as controls. Logistic regression analysis was used to analyze the impact of clinical characteristics on the outcome of conversion therapy for unresectable liver cancer.

A total of 142 patients with iuHCC were included in this study, of which 39 (27.4%) achieved conversion success, including 33 cases who underwent surgery, and 103 achieved conversion failure. The median follow-up time was 23 months. The overall survival time of patients with successful conversion therapy was significantly prolonged (47 months vs 18 months, P<0.001). Single-factor logistic regression analysis showed that using triple therapy (P=0.039), tumor distribution in one lobe (P=0.029), blood vessels not invaded by the tumor (P=0.001), C-reactive protein ≤8 mg/L (P=0.016), platelet count ≥125×10⁹/L (P=0.043), serum albumin ≥40 g/L (P=0.001), and international normalized ratio (INR) ≤1.15 (P=0.033) were protective factors for conversion therapy success. The results of multivariate logistic regression analysis suggested that using triple therapy (hazard ratio [HR]=0.256, 95% confidence interval [CI]: 0.071~0.930, P=0.038), blood vessels not invaded by the tumor (HR=0.238, 95%CI: 0.093~0.609, P=0.003) and serum albumin >40 g/L (HR=0.384, 95%CI: 0.155~0.950, P=0.038) were independent protective factors for successful conversion therapy in patients with iuHCC.

Vascular invasion and serum albumin level are key factors affecting the outcome of conversion therapy of iuHCC. If the patient's general condition is good, triple therapy should be actively used for conversion therapy.