Lin et al. report an elegant single-arm trial of neoadjuvant nivolumab plus ipilimumab in potentially resectable hepatocellular carcinoma (HCC), integrating long-term survival, pathological response and sophisticated biomarker analysis.1 Their observations linking pathological response with tertiary lymphoid structures offer compelling biological support for perioperative immune checkpoint inhibition in HCC. However, while Lin et al. address the “potentially resectable” space, their work also exposes a broader evidence gap – conversion surgery in first-line immunotherapy for unresectable disease remains undefined, unmeasured, and statistically invisible in major trials according to current international guidance.
Lin et al. report an elegant single-arm trial of neoadjuvant nivolumab plus ipilimumab in potentially resectable hepatocellular carcinoma (HCC), integrating long-term survival, pathological response and sophisticated biomarker analysis.1 Their observations linking pathological response with tertiary lymphoid structures offer compelling biological support for perioperative immune checkpoint inhibition in HCC. However, while Lin et al. address the “potentially resectable” space, their work also exposes a broader evidence gap – conversion surgery in first-line immunotherapy for unresectable disease remains undefined, unmeasured, and statistically invisible in major trials according to current international guidance.