Ignore reality but not the consequences of its ignorance: Broaden guidelines in surgery of hepatocellular carcinoma

Moris, Demetrios; Felekouras, Evangelos

doi:10.1002/hep.28984

Cited by 17 publications

(8 citation statements)

References 8 publications

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“…Nevertheless, these criteria have been considered too vague, with studies showing heterogeneous outcomes after resection of HCC within the same stage. In addition, several investigators have recently advocated extending the criteria for resection, acknowledging that certain patients with BCLC‐B HCC may benefit more from surgery than other locoregional therapies (TACE). The prognostic discrimination as well as the treatment allocation of the revised BCLC classification have been questioned, emphasizing the need for refinement and further subclassification of this system.…”

Section: Introductionmentioning

confidence: 99%

Hepatocellular carcinoma tumour burden score to stratify prognosis after resection

Tsilimigras

Moris

Hyer

et al. 2020

British Journal of Surgery

103

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Background Although the Barcelona Clinic Liver Cancer (BCLC) staging system has been largely adopted in clinical practice, recent studies have emphasized the need for further refinement and subclassification of this system. Methods Patients who underwent hepatectomy with curative intent for BCLC‐0, ‐A or ‐B hepatocellular carcinoma (HCC) between 2000 and 2017 were identified using a multi‐institutional database. The tumour burden score (TBS) was calculated, and overall survival (OS) was examined in relation to TBS and BCLC stage. Results Among 1053 patients, 63 (6·0 per cent) had BCLC‐0, 826 (78·4 per cent) BCLC‐A and 164 (15·6 per cent) had BCLC‐B HCC. OS worsened incrementally with higher TBS (5‐year OS 77·9, 61 and 39 per cent for low, medium and high TBS respectively; P < 0·001). No differences in OS were noted among patients with similar TBS, irrespective of BCLC stage (61·6 versus 58·9 per cent for BCLC‐A/medium TBS versus BCLC‐B/medium TBS, P = 0·930; 45 versus 13 per cent for BCLC‐A/high TBS versus BCLC‐B/high TBS, P = 0·175). Patients with BCLC‐B HCC and a medium TBS had better OS than those with BCLC‐A disease and a high TBS (58·9 versus 45 per cent; P = 0·005). On multivariable analysis, TBS remained associated with OS among patients with BCLC‐A (medium TBS: hazard ratio (HR) 2·07, 95 per cent c.i. 1·42 to 3·02, P < 0·001; high TBS: HR 4·05, 2·40 to 6·82, P < 0·001) and BCLC‐B (high TBS: HR 3·85, 2·03 to 7·30; P < 0·001) HCC. TBS could also stratify prognosis among patients in an external validation cohort (5‐year OS 79, 51·2 and 28 per cent for low, medium and high TBS respectively; P = 0·010). Conclusion The prognosis of patients with HCC varied according to the BCLC stage but was largely dependent on the TBS.

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Section: Introductionmentioning

confidence: 99%

Hepatocellular carcinoma tumour burden score to stratify prognosis after resection

Tsilimigras

Moris

Hyer

et al. 2020

British Journal of Surgery

103

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“…Of note, for non-surgical candidates, combination multimodality therapy (i.e., TACE + RFA) may be associated with acceptable outcomes. A recent systematic review and meta-analysis of 8 retrospective studies and one randomized controlled trial compared oncologic outcomes of combination therapy (i.e., TACE + RFA) vs. surgical resection of HCC [21] . Following propensity score matching, there were no differences in 1-, 3-and 5-year OS and DFS among patients receiving combination therapy vs. surgical resection; TACE + RFA was, however, associated with lower morbidity vs. resection [21] .…”

Section: Resection Beyond Bclc Criteria: Is It Justified In Select Patients?mentioning

confidence: 99%

“…A recent systematic review and meta-analysis of 8 retrospective studies and one randomized controlled trial compared oncologic outcomes of combination therapy (i.e., TACE + RFA) vs. surgical resection of HCC [21] . Following propensity score matching, there were no differences in 1-, 3-and 5-year OS and DFS among patients receiving combination therapy vs. surgical resection; TACE + RFA was, however, associated with lower morbidity vs. resection [21] . While BCLC criteria may be too restrictive, rigorous case selection to identify the best candidates for surgical resection is critical to achieve acceptable outcomes among patients with HCC beyond the BCLC guidelines.…”

Section: Resection Beyond Bclc Criteria: Is It Justified In Select Patients?mentioning

confidence: 99%

Hepatocellular carcinoma beyond Barcelona clinic liver cancer resection criteria: resecting the aggressive tumor

Tsilimigras¹,

Pawlik²

2021

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According to the Barcelona Clinic Liver Cancer (BCLC) staging system, surgical resection is recommended only for BCLC-0 and BCLC-A hepatocellular carcinoma (HCC). Nevertheless, several investigators have recently advocated for widening the resection criteria for HCC to select patients with BCLC-B and less frequently BCLC-C tumors. The available studies have reported a 5-year survival rate ranging from 25% to 63% following resection of select patients with multinodular HCC. The role of liver resection for macrovascular invasive HCC still remains unclear. The present review aimed to summarize the available evidence regarding the outcomes of patients who underwent resection for BCLC-B/C HCC as well as highlight the proposed criteria for resection beyond the current BCLC guidelines.

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“…Despite the wide adoption of the BCLC criteria by the surgical community, recent studies have shown improved perioperative outcomes and long-term survival for sporadic BCLC B and C patients managed surgically. [9][10][11][12] However, available evidence on recurrence patterns and survival of patients undergoing resection beyond the BCLC guidelines is lacking.…”

mentioning

confidence: 99%

Liver Resection for Hepatocellular Carcinoma and the Barcelona Clinic Liver Cancer Criteria: Is It Time to Push the Limits?

Naar

Hatzaras

2020

Ann Surg Oncol

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Ignore reality but not the consequences of its ignorance: Broaden guidelines in surgery of hepatocellular carcinoma

Cited by 17 publications

References 8 publications

Hepatocellular carcinoma tumour burden score to stratify prognosis after resection

Hepatocellular carcinoma tumour burden score to stratify prognosis after resection

Hepatocellular carcinoma beyond Barcelona clinic liver cancer resection criteria: resecting the aggressive tumor

Liver Resection for Hepatocellular Carcinoma and the Barcelona Clinic Liver Cancer Criteria: Is It Time to Push the Limits?

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