Anti-PD-1 therapy for preventing recurrence and improving survival in hepatocellular carcinoma patients after hepatectomy

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, with a high recurrence rate after resection. This study investigates the efficacy of postoperative anti-PD-1 antibody therapy on overall survival (OS) and recurrence-free survival (RFS) in HCC patients, with a particular focus on those positive for vessels encapsulating tumor clusters (VETC), a marker of aggressive disease behavior and high recurrence risk. This prospective observational study analyzed data from HCC patients who underwent curative liver resection between June 2015 and June 2022. Patients were divided into two groups based on postoperative anti-PD-1 antibody treatment. Propensity score matching (PSM) was employed to balance baseline characteristics. Kaplan-Meier analysis was used to assess OS and RFS, while Cox regression models identified prognostic factors. Subgroup analyses focused on the impact of VETC status on treatment outcomes. A total of 388 patients were included, with 148 receiving anti-PD-1 therapy. Both OS and RFS were significantly improved in the anti-PD-1 group before and after PSM. Specifically, postoperative anti-PD-1 therapy yielded notably better survival outcomes in VETC-positive patients. In contrast, no significant difference in OS (HR = 0.74 [0.53-1.02], P = 0.069) or RFS (HR = 0.79 [0.56-1.12], P = 0.184) was observed between treatment groups among VETC-negative patients, indicating that VETC status may guide postoperative immunotherapy. Cox regression analysis identified VETC as a risk factor for OS and RFS in HCC patients, while anti-PD-1 therapy emerged as a protective factor for both outcomes, particularly for high-risk, VETC-positive patients. Postoperative anti-PD-1 therapy significantly improves OS and RFS in HCC patients, especially those with VETC positivity, highlighting its potential as an effective adjuvant treatment for high-risk patients. VETC may serve as a valuable prognostic biomarker, aiding in the development of postoperative immunotherapy strategies to improve long-term outcomes in HCC.