Table 3.

Evidence for systemic therapy plus local therapy in conversion therapy

Ref.	Treatment regimen	Number of patients, n (%)	Study results
Zhang et al[37], 2020	TKI: Lenvatinib. PD-1 antibody: Pembrolizumab/Sintilimab/Toripalimab	33	Success rate of conversion (imaging): 42.4%. Actual surgery rate following conversion: 30.3%
Li et al[40], 2017	TACE + sorafenib	142	Second-stage resection rate following stage reduction: 14.8%
He et al[39], 2019	HAIC + sorafenib	125	Surgical resection rate following conversion: 12.8%
He et al[41], 2018	HAIC + sorafenib	35	Surgical resection rate following conversion: 14.3%
Zhang et al[42], 2021	HAIC + TKI + PD-1 antibody (1, 7, and 17 patients used sorafenib, apatinib, and lenvatinib, respectively)	25	Surgical resection rate following conversion: 56.0%, 7 patients (28.0%) achieved pathologically complete remission
He et al[38], 2021	Lenvatinib + toripalimab + HAIC	71	Surgical resection rate following conversion: 12.7%

Grade of evidence in the guideline of Chinese Society of Clinical Oncology diagnosis and treatment. Feature of evidence; grade; level; sources; Chinese Society of Clinical Oncology degree of expert consensus; 1A: High, rigorous meta-analysis, large-scale randomized clinical study, unified consensus (supportive opinion: ≥ 80%); 1B: High, rigorous meta-analysis, large-scale randomized clinical study, generally unified consensus, with slight controversy (supportive opinion: 60%-80%); 2A: Slightly low, fair-quality meta-analysis, generally unified consensus, with slight controversy (supportive opinion: 60%-80%) or small-scale randomized clinical study, well-designed large-scale retrospective study, case-control study, unified consensus (supportive opinion: ≥ 80%); 2B: Slightly low, fair-quality meta-analysis, small-scale randomized clinical study, well-designed large-scale air-quality meta-analysis, generally unified consensus, with slight controversy (supportive opinion: 60%-80%) or small-scale randomized clinical study, well-designed large-scale retrospective study, case-control retrospective study, case-control study; generally unified consensus, with slight controversy (supportive opinion: 60%-80%); 3: Low, non-controlled single-arm clinical study, case report, expert opinion, no consensus, with low substantial controversy (supportive opinion: < 60%). TKI: Tyrosine kinase inhibitor; PD-1: Programmed cell death protein-1; TACE: Transarterial chemoembolization; HAIC: Hepatic arterial infusion chemotherapy.