Abstract
Background
Liver resection for hepatocellular carcinoma beyond the Barcelona Clinic Liver Cancer
criteria remains controversial. Strict candidate selection is crucial to achieve optimal
results in this population. This study explored postoperative outcomes and developed
a preoperative predictive formula to identify patients most likely to benefit from
liver resection.
Methods
In total, 382 patients who underwent liver resection for hepatocellular carcinoma
beyond the Barcelona Clinic Liver Cancer resection criteria between 2000 and 2017
were identified from a multicenter database with the Hiroshima Surgical study group
of Clinical Oncology. An overall survival prediction model was developed, and patients
were classified by risk status.
Results
The 5-year overall survival after curative resection was 50.0%. Overall survival multivariate
analysis identified that a high a-fetoprotein level, macrovascular invasion, and high
total tumor burden were independent prognostic risk factors; these factors were used
to formulate risk scores. Patients were divided into low-, moderate-, and high-risk
groups; the 5-year overall survival was 65.7%, 49.5%, and 17.0% (P < .001), and the 5-year recurrence-free survival was 31.3%, 26.2%, and 0%, respectively
(P < .001). The model performance was good (C-index, 0.76). Both the early and extrahepatic
recurrence increased with higher risk score.
Conclusion
The prognosis of patients with hepatocellular carcinoma beyond the Barcelona Clinic
Liver Cancer resection criteria depended on a high a-fetoprotein level, macrovascular
invasion, and high total tumor burden, and risk scores based on these factors stratified
the prognoses. Liver resection should be considered in patients with hepatocellular
carcinoma beyond the Barcelona Clinic Liver Cancer criteria with a low or moderate-risk
score.
Graphical abstract
Graphical Abstract
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Article info
Publication history
Published online: October 29, 2021
Accepted:
September 11,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
