Editor's Note: Since 2015, the Chinese Society of Clinical Oncology (CSCO) has adhered to the philosophy of "International Standards, Chinese Characteristics, Learning and Absorbing, Innovating and Improving," launching the "Annual Research Advances in Chinese Clinical Oncology" for nine consecutive years. At the recently held "2024 Annual Progress Seminar on Chinese Clinical Oncology (BOC) and Best of ASCO 2024 China," the "Annual Research Advances in Chinese Clinical Oncology 2023" was officially released. Professor Tian Yang from The Third Affiliated Hospital of Naval Medical University (Shanghai Eastern Hepatobiliary Surgery Hospital) reported on the "Annual Research Advances in Chinese Clinical Oncology 2023 (Hepatobiliary and Pancreatic Tumors)." The report is summarized below.

Dr. Mingda Wang  from the Third Affiliated Hospital of Naval Medical University (Shanghai Eastern Hepatobiliary Surgery Hospital) presented on behalf of Professor Tian Yang.

The Hepatobiliary and Pancreatic Group of the CSCO Youth Expert Committee imported 9,969 articles from the SCI database for data analysis, using 7,770 articles (excluding studies from Taiwan, China) to evaluate the top 20 journals and their impact factors (IF), the number of articles published in 20 key journals, and the top 20 research institutions and authors. A total of 121 articles were included for hepatobiliary and pancreatic tumors, comprising 90 on liver, 16 on biliary tract, and 15 on pancreas, covering the following key research advances.

01

Hepatic Tumor Surgery Advances

• Professor Xiaoping Chen et al., published in Ann Surg, conducted a propensity score-matched prospective study evaluating the impact of robot-assisted, laparoscopic, and open surgery on the prognosis of early liver cancer. The results showed no significant difference in 5-year disease-free survival (DFS) and overall survival (OS) rates among the open, laparoscopic, and robotic groups, confirming the safety and efficacy of both open and minimally invasive surgeries for early hepatocellular carcinoma (HCC).
• Professor Rongping Guo et al., published in J Clin Oncol, conducted a multicenter phase 3 study using FOLFOX hepatic arterial infusion chemotherapy as adjuvant treatment for HCC with microvascular invasion. The results showed improved DFS for these patients, with tolerable adverse reactions and good safety.
• Professor Weiping Zhou et al., published in JAMA Netw Open, explored the use of tenofovir versus entecavir in HBV-related HCC patients post-resection, showing that tenofovir was associated with better OS and recurrence-free survival (RFS), providing new insights into antiviral therapy for HBV-related liver cancer.

02

Local Treatment Advances for Hepatic Tumors

• Professor Yangkui Gu et al., published in STTT, conducted the phase 2 TRIPLET study using camrelizumab plus apatinib combined with hepatic arterial infusion chemotherapy (HAIC) for Barcelona Clinic Liver Cancer (BCLC) stage C liver cancer, showing encouraging efficacy and controllable safety.
• Academician Gaojun Teng et al., published in STTT, conducted a real-world study evaluating PD-(L)1 inhibitors combined with molecular targeted therapy and transarterial chemoembolization (TACE) for advanced liver cancer, showing good PFS, OS, and objective response rate (ORR) with acceptable safety.
• Professor Zhijun Chen et al., published in Lancet Gastroenterol Hepatol, conducted the single-arm phase 2 START-FIT study, the first prospective trial combining immunotherapy and local treatment as a conversion therapy for locally advanced unresectable HCC, with promising initial results offering new options for these patients.

03

Systemic Treatment Advances for Hepatic Tumors

• Professors Shukui Qin, Chunyi Hao et al., published in J Clin Oncol, conducted the phase 3 KEYNOTE-394 study comparing pembrolizumab versus placebo as second-line treatment for advanced liver cancer in Asia, showing significant improvements in OS, PFS, and ORR.
• Professor Zongxiang Qiu et al., published in J Clin Oncol, reported the CheckMate 040 cohort 6 study, showing nivolumab combined with cabozantinib, with or without ipilimumab, exhibiting promising preliminary antitumor activity in advanced HCC patients, consistent with the safety of the individual drugs.
• Professors  Shukui Qin et al., published in JAMA Oncol, conducted the phase 3 RATIONALE-301 study, showing that tislelizumab as first-line treatment for advanced unresectable liver cancer had comparable OS, longer PFS, and higher ORR compared to sorafenib.

04

Advances in Biliary Tract Tumors

• Professor Jian Zhou et al., published in STTT, conducted a single-arm phase 2 study evaluating the efficacy and safety of toripalimab, lenvatinib, and GEMOX (gemcitabine plus oxaliplatin) for first-line treatment of advanced intrahepatic cholangiocarcinoma.
• Professor Zhangjun Cheng et al., published in Aliment Pharmacol Ther, evaluated the efficacy of different PD-1 inhibitors combined for the treatment of unresectable intrahepatic cholangiocarcinoma.
• Professor Xiaofeng Chen et al., published in JHEP Rep, conducted a single-arm phase 2 study using immunogenomic-radiomics to predict the efficacy of camrelizumab combined with GEMOX chemotherapy for biliary tract cancer.

05

Advances in Pancreatic Tumors

• Professor Jianping Lu et al., published in Nat Med, demonstrated that artificial intelligence for pancreatic cancer detection could accurately detect and distinguish pancreatic lesions through CT scans, potentially becoming a new large-scale screening tool for pancreatic cancer.
• Professor Song Gao et al., published in Int J Surg, conducted a retrospective cohort study showing significant survival benefits of selective extended resection for patients with perineural invasion outside the pancreas, displaying special efficacy and safety in resectable pancreatic ductal adenocarcinoma.
• Professor Jihui Hao et al., published in Int J Surg, conducted a retrospective cohort study showing that surgery after neoadjuvant therapy improved OS in patients with IB-III stage pancreatic ductal adenocarcinoma but did not significantly benefit IA stage patients.

06

Advances in Basic Research, Diagnosis, and Prediction for Liver Cancer

• Professor Guoyue Lü et al., published in Gut, analyzed gross pathological margin morphology classification for clinical stratification management of HCC from clinical variables to multi-omics.
• Professor Chunfeng Qu et al., published in Nat Cancer, conducted a multicenter prospective study evaluating the performance and effectiveness of HCC screening in Chinese HBsAg-positive populations.
• Professor Min Zheng et al., published in Int J Epidemiol, explored the proportion of new liver cancer cases and deaths attributable to potentially modifiable risk factors in China.

After analyzing the included literature, the expert group recommended three significant research advances in the field of hepatobiliary and pancreatic tumors in China for 2023:

1. The Lancet published the international multicenter phase 3 CARES-310 study led by Professor Shukui Qin, comparing camrelizumab plus apatinib versus sorafenib as first-line treatment for unresectable HCC. This is the first large-scale phase 3 clinical trial achieving positive PFS and OS dual endpoints with an immune checkpoint inhibitor combined with a small molecule TKI for advanced HCC. The results confirmed that camrelizumab plus apatinib (“double A” combination) is effective and safe, bringing new treatment options for patients.
2. The Lancet published the international multicenter phase 3 IMbrave050 study led by Professor Shukui Qin, comparing atezolizumab plus bevacizumab versus active surveillance for high-risk recurrent HCC patients post-resection or ablation. This is the first phase 3 clinical trial in the adjuvant treatment of HCC achieving positive results, confirming that atezolizumab plus bevacizumab (“T+A” combination) can significantly improve RFS and reduce recurrence compared to active surveillance, potentially revolutionizing adjuvant treatment standards for HCC.
3. J Clin Oncol published the phase 3 LAUNCH study conducted by Professor Ming Kuang et al., evaluating lenvatinib combined with TACE as first-line treatment for advanced HCC. This is the first global randomized controlled study showing that combining systemic and local treatments improves OS in advanced HCC patients, achieving significant improvements in OS, PFS, and ORR with good safety, offering a new first-line treatment option for advanced HCC.

In summary, 2023 saw substantial research achievements by Chinese scholars in hepatobiliary and pancreatic tumors, from basic research to clinical exploration and combined applications of various treatments. The number of published articles is encouraging, particularly in exploring adjuvant treatment for high-risk early-stage patients and combining local and systemic treatments for mid- to late-stage patients to increase conversion surgery opportunities. However, the majority of published papers were still basic and retrospective studies, with relatively few multicenter or single-center randomized clinical trials. There were 17 such trials in 2023, including 6 on hepatic tumor surgery and 11 on systemic treatment. It is hoped that in the future, Chinese scholars in hepatobiliary and pancreatic tumors will collaborate to conduct more high-quality, multicenter, prospective clinical trials, showcasing more “Chinese wisdom” and more “Chinese solutions” in top international journals, thus meeting the clinical treatment needs of more patients with hepatobiliary and pancreatic tumors.

Professor Tian Yang

• Director of the Central Laboratory of the Clinical Research Institute, Third Affiliated Hospital of Naval Medical University
• Deputy Director and Deputy Secretary of the Party Branch, Second Department of Hepatobiliary Surgery
• Standing Committee Member of the Youth Committee and Member of the Liver Cancer Expert Committee, Chinese Society of Clinical Oncology (CSCO)
• Secretary General, Chinese Chapter of the International Hepato-Pancreato-Biliary Association (CC-IHPBA)
• Deputy Leader, Youth Expert Working Group on Hepatobiliary Surgery, Chinese Medical Doctor Association
• Trained under Academician Wu Mengchao and advanced clinical visiting scholar at Mount Sinai School of Medicine, New York
• Executive Editor of the Chinese Science Excellence Journal iLIVER, Associate Editor of View Medicine and Front Immun, Editorial Board Member of HBPD Int, HPB, JCTH, eGastro, and 24 other domestic and international journals
• First or corresponding author (including co-author) of 138 SCI papers in journals such as Gut, J Hepatol, Hepatology, Adv Mater, Small, JAMA Surg, Ann Surg with a total impact factor (IF) exceeding 900, including 25 papers with an IF over 10 and a highest IF of 32.09 (cover article), cited over 5800 times, with an H-index of 39
• First or last corresponding author of 132 SCI reviews and communications in Lancet (4 articles), BMJ (4 articles), Lancet Oncol, J Clin Oncol, Gut, etc., with 21 articles having an IF over 30
• Recognized as an Outstanding Academic Leader in Shanghai, a Leading Figure in Health and Wellness in Shanghai, an Outstanding Young Medical Talent in Shanghai, a Shanghai Shuguang Scholar, a Shanghai Pujiang Talent, a Shanghai Youth Top Talent, a Shanghai Youth Science Star, an Excellent Young Talent in the Shanghai Health System, a Military Youth Science and Technology Elite, and an Excellent Professional Talent in the Military
• Recipient of the National Wu Mengchao Medical Youth Award, the First People’s Good Doctor “Jinshan Camellia” Outstanding Contribution Gold Award, and the highest award for young talents in the Shanghai Health System, the “Silver Snake Award”
• Principal investigator of 5 National Natural Science Foundation projects and 12 provincial and ministerial-level projects, holder of 4 national invention patents, 22 utility model patents, and software copyright patents, and recipient of two First Prizes of the Shanghai Science and Technology Progress Award

This report highlights the significant strides and comprehensive efforts made by Chinese researchers in the field of hepatobiliary and pancreatic tumors, reflecting the collaborative and innovative spirit driving progress and improvements in cancer treatment.