Researchers at Cedars-Sinai Cancer Center have determined that patients with advanced liver cancer who underwent tumor removal surgery or organ transplantation following immunotherapy experienced significantly longer survival rates compared to those who only received drug-based treatment.
The study’s findings were published in the journal Liver Cancer. Specialists analyzed data from 4,329 individuals diagnosed with hepatocellular carcinoma (liver cancer) using the U.S. National Cancer Database, which accounts for over 70% of all new cancer diagnoses nationally. The average age of the patients was 66, with 81% being male. One-third of the cohort presented with T4 stage disease, 22% had lymph node involvement, and 32% had distant metastases.
Out of all patients who initially received immunotherapy, only 138 individuals—approximately 3.2%—subsequently underwent surgery. Of these, 54% had a partial liver resection, 25% had local ablation (tumor burning), and 20% received a liver transplant. On average, three months elapsed between the start of immunotherapy and the surgical intervention.
Overall survival for the surgically treated group was markedly superior: the median survival time for the non-operative group was 10 months, whereas the operative group did not reach median survival by the study’s conclusion, meaning more than half of those patients were still alive when the observation period ended. The risk of death for operated patients was 6 to 7 times lower than for those who did not receive surgery.
Dr. June Dong Yang, director of the Hepatocellular Carcinoma Program at Cedars-Sinai, plainly summarized the findings: “Individuals who received a liver transplant or tumor removal after immunotherapy live considerably longer than those who remain solely on medication.”
A critical discovery involved the likelihood of accessing such surgery: patients treated at major academic medical centers were three times more likely to undergo operation compared to those in community hospitals. Academic centers concentrate multidisciplinary teams, offer access to cutting-edge therapies, and possess specialized surgical expertise.
The core challenge with liver cancer is its infrequent detection at an early stage; most patients learn of their diagnosis only after the tumor has already spread. Immunotherapy—particularly immune checkpoint inhibitors—can shrink tumors, but it usually cannot cure this type of cancer completely on its own. However, if the drugs manage to reduce the disease to a surgically manageable state, the surgeon gains an opportunity to eliminate the remaining disease.
However, this approach has notable limitations. Immunotherapy can sometimes trigger liver inflammation—immune hepatitis—which subsequently renders surgery impossible. Furthermore, in some patients, the tumor metastasizes while the drugs are active, making transplantation not only futile but dangerous, as the immunosuppressant drugs required post-transplant can accelerate the growth of existing metastases.
The availability of this treatment remains a pressing issue. Immunotherapy costs several thousand dollars per course, while liver transplantation is among the most expensive medical procedures globally, costing hundreds of thousands of dollars. Even in affluent nations, patients wait years for a transplant slot. Only a few U.S. clinics routinely perform these specific operations following immunotherapy, as noted by Liver Cancer.
Robert Figlin, interim director of the Cedars-Sinai Cancer Center, remarked, “When physician-scientists structure their work around patient needs and promptly translate discoveries into clinical application, it alters the destinies of both their immediate patients and sufferers worldwide. This is the mission of an academic medical center.”
In the coming months, Dr. Yang plans to initiate a new prospective study; he intends to enroll patients undergoing transplantation post-immunotherapy and meticulously track their outcomes. Specialists estimate that if this research validates the safety and efficacy of the method, it could enter broad clinical practice within approximately 5 to 7 years.
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