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Conversion therapy yields 25.4% pooled resection rate in unresectable HCC across 34 studiesConversion therapy helps some patients with liver cancer surgery

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Key Takeaway
Interpret the 25.4% pooled resection rate cautiously given high heterogeneity.

This meta-analysis pooled data from 34 studies including 5,137 patients with initially or baseline unresectable hepatocellular carcinoma to estimate resection rates after conversion therapy. The crude aggregate resection rate was 20.3% (1,042/5,137), while the random-effects modeled pooled resection rate was 25.40% (95% CI, 20.74%-30.69%).

The authors reported substantial heterogeneity (I2=91.5%; tau2=0.5132). The Hartung-Knapp adjusted confidence interval was 20.12%-31.51%, and the prediction interval ranged from 7.16% to 60.04%, indicating that individual study estimates varied widely. Leave-one-out estimates ranged from 24.52% to 26.64%.

Treatment-strategy differences were not statistically significant (Qm=5.17, df=2; P = 0.075). Publication-year meta-regression showed no clear linear association (OR per decade 1.19; 95% CI 0.77-1.83; P = 0.440). Egger's test for funnel asymmetry was not significant (P = 0.381).

The authors note high heterogeneity as a limitation. Adverse events, follow-up duration, and funding or conflicts were not reported. The pooled estimate is described as a cross-study, cross-era benchmark for multidisciplinary decision-making rather than a universal patient-level probability or a treatment-specific efficacy estimate. The analysis is association only.

How this fits prior evidence

This meta-analysis extends prior HCC coverage by quantifying resection outcomes after conversion therapy, a treatment strategy not addressed in earlier items. Prior coverage focused on molecular differences between cholangiocarcinoma and HCC, diagnostic challenges such as tonsillar metastasis, clinicoradiomics for microvascular invasion prediction, and prognostic markers like the CALLY index. None of those addressed conversion therapy or resection rates. The present synthesis provides a pooled benchmark but does not confirm or contrast with those specific findings, as it addresses a distinct clinical question.

Living with liver cancer, specifically hepatocellular carcinoma, often means facing a difficult reality: the tumor may be too large or advanced to remove. However, some patients use conversion therapy to shrink the tumor enough to make surgery possible. This is a critical step for those hoping to move toward a more definitive treatment.

Researchers looked at data from over 5,000 patients to see how often this strategy works. They found that about 25% of patients who initially could not have surgery were eventually able to undergo a procedure called a hepatectomy. While this number shows that conversion therapy can work, it is important to remember that these results come from a wide variety of studies. This means the success rate can vary significantly depending on the specific clinic or treatment plan.

Because the data comes from many different sources, the results are a general benchmark rather than a guarantee for every individual. The study did not find a clear link between the year of publication and success rates, nor did it find significant differences based on specific treatment strategies. Talk to your medical team to see how these general findings apply to your specific situation.

What this means for you:
Conversion therapy allows about 25% of patients with unresectable liver cancer to become eligible for surgery.

Common questions

What is conversion therapy for liver cancer?

Conversion therapy is a treatment strategy used for patients with hepatocellular carcinoma who cannot initially have surgery. The goal is to shrink the tumor enough so that the patient can eventually undergo a hepatectomy, which is the surgical removal of part of the liver.

How many patients can actually get surgery after conversion therapy?

Data from 5,137 patients shows that the pooled resection rate is about 25.40%. This means that roughly one in four patients who were initially unable to have surgery were successfully converted to a state where surgery was possible.

Does the success of conversion therapy change based on the year of treatment?

The study looked at whether older or newer treatments performed differently. They found no clear linear association between the year of publication and success rates, meaning the results remained consistent across different time periods.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
IntroductionConversion therapy may create an opportunity for liver resection in selected patients with initially unresectable hepatocellular carcinoma (HCC), but reported conversion rates use heterogeneous denominators and endpoints. We estimated actual completed hepatectomy using a verified all-treated denominator.MethodsPubMed/MEDLINE, Embase, Web of Science Core Collection, Cochrane Library/CENTRAL, Wanfang Data, and CNKI were searched through April 10, 2026. Eligible cohorts included initially or baseline unresectable HCC, an all-treated denominator, and completed liver resection events. Two authors independently assessed eligibility, extracted data, and evaluated risk of bias. Random-effects logit proportion meta-analysis, Hartung-Knapp sensitivity, prediction intervals, leave-one-out analyses, treatment-strategy subgroups, publication-year meta-regression, and small-study-effect diagnostics were undertaken. PROSPERO: CRD420261360108.ResultsThirty-seven reports represented 36 unique studies; 34 studies involving 5,137 patients and 1,042 completed hepatectomies entered the quantitative synthesis. The crude aggregate resection rate was 20.3% (1,042/5,137), whereas the random-effects modeled pooled rate was 25.40% (95% CI, 20.74%-30.69%; I2=91.5%; tau2=0.5132). The Hartung-Knapp 95% CI was 20.12%-31.51%, and the prediction interval was 7.16%-60.04%. Leave-one-out estimates ranged from 24.52% to 26.64%. Treatment-strategy differences were not statistically significant (Qm=5.17, df=2, P = 0.075). Publication-year meta-regression did not show a clear linear association (OR per decade 1.19, 95% CI 0.77-1.83; P = 0.440), and Egger’s test did not indicate significant funnel asymmetry (P = 0.381).ConclusionsApproximately one-quarter of patients initiating conversion therapy underwent actual hepatectomy, but the crude and modeled estimates differ because substantial heterogeneity changes random-effects study weighting. The pooled estimate is a cross-study, cross-era benchmark for multidisciplinary decision-making rather than a universal patient-level probability or a treatment-specific efficacy estimate.Systematic Review Registrationwww.crd.york.ac.uk/prospero/, identifier CRD420261360108.
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