Surgery and immunotherapy for liver cancer: the right order for the best effectiveness
In the treatment of hepatocellular carcinoma, immunotherapy is more effective when administered prior to surgery than when administered afterwards.
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Hepatocellular carcinoma (HCC) is the most common type of liver cancer in Switzerland and worldwide. For eligible patients, liver surgery or hepatectomy is an effective treatment option. However, recurrence remains a major challenge after hepatectomy, affecting more than 40% of patients within three years of resection.
Immunotherapy using immune checkpoint inhibitors (ICIs), which has revolutionized the treatment of many types of cancer, is being considered as a parallel treatment to surgery in order to limit HCC recurrence. However, the optimal treatment window is still under debate. Is it more beneficial to administer ICIs before (as neoadjuvant) or after (as adjuvant) hepatectomy?
The study published in the journal demonstrated that the efficacy of ICI treatment was lost when administered after surgery. This loss of efficacy is correlated with reduced infiltration of cytotoxic T lymphocytes, the main players in anti-tumor immunity, into the tumor, but also with reduced activation of these cells.
In contrast, ICI treatment prior to surgery significantly reduced tumor burden, improved immune cell infiltration and increased the expression of key cytotoxic T cell activation markers. In addition, this neoadjuvant treatment significantly reduced recurrence rates and improved survival, which was not achieved with adjuvant treatment.
This loss of adjuvant treatment efficacy is linked to several factors, including inflammation associated with surgery, which by attracting immune cell types that are not specific to anti-tumor immunity can induce immunosuppression.
This work contributes to a better understanding of perioperative immunotherapy strategies and provides guidance for the clinical application of immunotherapies in HCC with a view to reducing recurrence.
22 Oct 2025