Neoadjuvant hepatic arterial infusion of oxaliplatin, fluorouracil, and leucovorin for resectable single large hepatocellular carcinoma.

Objective: Patients diagnosed with single large hepatocellular carcinoma (HCC) often face a daunting prognosis and pose a treatment challenge. In this study, we aimed to evaluate the effectiveness of neoadjuvant hepatic arterial infusion chemotherapy (HAIC) with oxaliplatin, fluorouracil, and leucovorin (FOLFOX) in patients with single large HCC.

Methods: 397 patients with resectable single, ≥7 cm HCC from three centers in China between January 2016 and December 2021 were included, 268 patients underwent hepatectomy alone and 129 patients underwent neoadjuvant HAIC. The log-rank test was used to compare the overall survival (OS) and disease-free survival (DFS) by intension-to-treat analysis between the two groups.

Results: The 1-, 3-, and 5-year OS rates were 83.3%, 62.9%, and 53.8% in the surgery alone group, and 97.5%, 80.7%, and 64.7% in the neoadjuvant HAIC group. The 1-, 3-, and 5-year DFS rates were 48.8%, 32.5%, and 26.2% in the surgery alone group, and 71.5%, 61.7%, and 59.5% in the neoadjuvant HAIC group. The neoadjuvant HAIC group showed significantly longer OS (hazard ratio [HR], 0.506; 95% confidence interval [CI], 0.347-0.734; P < 0.001) and DFS (HR, 0.466; 95% CI, 0.357-0.609; P < 0.001) than the surgery alone group. There was no HAIC-related death in the neoadjuvant HAIC group.

Conclusions: Neoadjuvant FOLFOX-HAIC significantly improved the OS and DFS with acceptable toxicities in HCC patients with resectable single, ≥7 cm tumor.