Perioperative immunotherapy for resectable hepatocellular carcinoma.

# Perioperative immunotherapy for resectable hepatocellular carcinoma *The Lancet 2026* Correspondence Perioperative treatment strategies. Updates in global strategy optimisation in high-risk immunotherapy for guidelines from Asia–Pacific countries3 hepatocellular carcinoma after surgery. and US associations4 are reconsidering This milestone finding from Wang resectable the potential benefit of a surgery- and colleagues is expected to improve hepatocellular centred multidisciplinary strategy for surgical outcomes for patients with advanced hepatocellular carcinoma. hepatocellular carcinoma through carcinoma Given the differences in the aetiological a surgery-centred multidisciplinary profiles and tumour characteristics treatment strategy. Nevertheless, We read with great interest the Article of hepatocellular carcinoma between further exploration is still required by Zheng Wang and colleagues,1 populations worldwide, cross-sectional in areas such as the cross-sectional and appreciate their novel findings. validations are urgently required to validation, the selection of optimal The study, centred around surgery, facilitate the generalisation of the neoadjuvant and adjuvant regimens, proposed a novel treatment of proposed strategies. and the identification of actual high- neoadjuvant therapy, radical Second, the sequential treatment risk populations. surgery, and adjuvant therapy, with incorporating neoadjuvant and adjuvant We declare no competing interests. This camrelizumab plus rivoceranib, in therapy has been shown to significantly Correspondence was supported by the Science and patients with resectable hepatocellular improve long-term surgical outcomes,1 Technology Plan Joint Program of Liaoning Province (2024JH2/102600286) awarded to YT. carcinoma at intermediate or high but patients with suboptimal response risk of recurrence. The trial showed to neoadjuvant therapy might derive Zhenli Li, *Yufu Tang that, compared with surgery alone, little survival benefit from the same tangyufu0227@163.com this approach significantly improved adjuvant regimen. In addition, although Department of Hepatobiliary Surgery, General the median event-free survival in the the IMbrave050 trial5 did not achieve Hospital of Northern Theater Command, Shenyang 110016, China (ZL, YT); Department of General selected population (42·1 months positive efficacy in the adjuvant setting, Surgery, the 963rd Hospital of the Joint Service [95% CI 23·2 to not estimable] vs a separate control group specifically for Support Force of the PLA, Jiamusi, China (ZL) 19·4 months [14·9 to not estimable]). adjuvant therapy should be established 1 Wang Z, Fan J, Zhou S, et al. Perioperative This study represents the first in a future study design, given the camrelizumab plus rivoceranib versus surgery alone in patients with resectable hepatocellular phase 2/3 clinical trial to achieve differences in medication regimens and carcinoma at intermediate or high risk of positive perioperative outcomes. enrolled populations. recurrence (CARES-009): a randomised phase 2/3 trial. Lancet 2025; 406: 4089–99. These encouraging findings will shift Third, the definition of patients with 2 Sangro B, Argemi J, Ronot M, et al, and the the current mainstream approach intermediate or high recurrence risk European Association for the Study of the from passive surveillance to an active primarily included a tumour diameter of Liver. EASL Clinical Practice Guidelines on the management of hepatocellular carcinoma. anti-recurrence strategy, offering new more than 5 cm, multiple tumours, and J Hepatol 2025; 82: 315–74. tactics for improving surgical outcomes macrovascular invasion—criteria that 3 Lau G, Obi S, Zhou J, et al. APASL clinical in patients at intermediate or high risk are broad and insufficient for identifying practice guidelines on systemic therapy for hepatocellular carcinoma—2024. Hepatol Int of recurrence. However, we would like the candidates that truly benefit from 2024; 18: 1661–83. to raise the following comments about adjuvant therapy. The IMbrave050 trial5 4 Taddei TH, Brown DB, Yarchoan M, Mendiratta-Lala M, Llovet JM. Critical Update: the Article. explicitly included poorly differentiated AASLD Practice Guidance on prevention, First, the controversy regarding the hepatocellular carcinoma and micro- diagnosis, and treatment of hepatocellular resectability criteria for hepatocellular vascular invasion in its definition of the carcinoma. Hepatology 2025; 82: 272–74. 5 Qin S, Chen M, Cheng AL, et al, and the carcinoma has existed between different population at high risk; however, these IMbrave050 investigators. Atezolizumab plus medical communities for decades. specific pathological variables were bevacizumab versus active surveillance in patients with resected or ablated high-risk Wang and colleagues defined patients not reported or incorporated into the hepatocellular carcinoma (IMbrave050): with Barcelona Clinic Liver Cancer subgroup analysis in this study. With a randomised, open-label, multicentre, stage B or stage C disease without the advancement of liquid biopsy, the phase 3 trial. Lancet 2023; 402: 1835–47. 6 Powles T, Kann AG, Castellano D, et al, and the Vp4 involvement or extrahepatic detection of minimal residual disease to IMvigor011 Investigators. ctDNA-guided metastasis as resectable populations. guide adjuvant therapy has become an adjuvant atezolizumab in muscle-invasive bladder cancer. N Engl J Med 2025; However, according to guidelines increasing focus of research. The latest 393: 2395–408. from the European Association for findings show that circulating tumour the Study of the Liver, these patients DNA can guide adjuvant atezolizumab already fall into the extremely high- in muscle-invasive bladder cancer,6 The CARES-009 trial showed that risk stratification and constitute a which is independent of stage and perioperative camrelizumab plus surgical contraindication.2 Substantial PD-L1 status. These findings provide rivoceranib significantly improves challenges will therefore arise from a new direction for future research event-free survival compared with the global adoption of the proposed on patient selection and treatment surgery alone in patients with 1332 --- [PDF原文](https://sci-net.xyz/storage/7932541/ebf5dd2dc777aa8ff57473bc0eb3c296b65435b00814c3d9df4a7327fa85c500/Perioperative-immunotherapy-for-resectable-hepatocellular-carcinoma.pdf) DOI: 10.1016/S0140-6736(26)00141-8