J.Jpn. Surg. Soc.. 127(2): 185-191, 2026

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Feature topic

THERAPEUTIC EVOLUTION IN HEPATOCELLULAR CARCINOMA: INTEGRATING IMMUNE CHECKPOINT INHIBITORS WITH SURGICAL STRATEGIES

Hepatocellular carcinoma (HCC) remains a malignancy with poor prognosis, for which surgical resection is the only potentially curative option. However, only a limited proportion of patients is resectable, and recurrence rates remain high. Conventional systemic therapies, such as molecular targeted agents and transcatheter arterial chemoembolization, have provided modest benefits with low response rates. The introduction of immune checkpoint inhibitors (ICIs) has dramatically changed the treatment landscape. Combination regimens, such as atezolizumab plus bevacizumab, tremelimumab plus durvalumab, and nivolumab plus ipilimumab, have achieved unprecedented response rates and improved survival. These advances have enabled conversion surgery in patients initially deemed unresectable. Standardized definitions of resectability and conversion surgery have enhanced consistency in clinical practice and research. Evidence suggests that ICI-based conversion surgery is feasible and associated with favorable survival rates. Several randomized trials are also evaluating ICIs as adjuvant therapy after curative treatment. However, optimal patient selection, treatment duration, and predictive biomarkers remain unclear. Refinement of response assessment and close collaboration among surgeons, oncologists, and radiologists will be essential to establish integrated strategies that improve long-term outcomes in advanced HCC.

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