Neoadjuvant immunotherapy in resectable hepatocellular carcinoma: A meta-analysis of the current evidence

BACKGROUND Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality worldwide. Despite improvements in surgical techniques and systemic therapies, long-term outcomes after liver resection are limited by high recurrence rates. While adjuvant strategies have shown limited benefit, the role of neoadjuvant immunotherapy in resectable HCC is still under investigation. AIM To assess the efficacy, feasibility, and safety of neoadjuvant immunotherapy in resectable HCC through a meta-analysis of current literature. METHODS A systematic search was conducted across PubMed, Web of Science, EMBASE, Cochrane Library, and Scopus for studies published in the past five years evaluating neoadjuvant immunotherapy in resectable HCC. Primary endpoints included major pathological response (MPR), pathological complete response (pCR), overall response rate (ORR), resection rate, and grade 3-4 treatment-related adverse events (TRAEs). A random-effects meta-analysis was conducted using log odds ratios (ORs) and pooled event rates were calculated to provide absolute estimates of clinical endpoints. RESULTS Twelve studies were included in the final analysis. The pooled ORs were 0.28 (95%CI: 0.19-0.41) for MPR, 0.54 (95%CI: 0.25-1.14) for ORR, 0.26 (95%CI: 0.11-0.66) for pCR, 5.37 (95%CI: 2.70-10.66) for resection rate, and 0.33 (95%CI: 0.22-0.50) for grade 3-4 TRAEs. Corresponding pooled event rates were 19% for MPR, 35% for ORR, 22% for pCR, 81% for resection feasibility, and 19% for severe TRAEs. CONCLUSION Neoadjuvant immunotherapy appears to be a feasible and safe approach in patients with resectable HCC, achieving moderate pathological responses and high resection rates.