Oncological Resectability Criteria for Hepatocellular Carcinoma in the Era of Novel Systemic Therapies: The Japan Liver Cancer Association and Japanese Society of Hepato-Biliary-Pancreatic Surgery Expert Consensus Statement 2023

AimThis study was undertaken to evaluate the outcome of curative liver resection, (LR) of Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma (BCLC‐C HCC) after tyrosine kinase inhibitors (TKIs) became approved as a treatment option for recurrent lesions.MethodsSixty‐seven patients with BCLC‐C HCC who underwent curative LR were enrolled in this study. The patients were classified into two groups according to whether LR was performed before (n = 24) or after (n = 43) TKI approval (“beforeTKI” and “afterTKI” group, respectively).ResultsThere was no difference in the median disease‐free survival time after LR between the beforeTKI and afterTKI groups (5.6 and 7.1 months, respectively; p = 0.435). However, the median survival time after LR was longer in the afterTKI than beforeTKI group (42.7 and 14.9 months, respectively; p = 0.022). Univariate and multivariate analyses showed that the date of LR was the only independent factor affecting postresection survival. When the patients were limited to those with recurrence, there were no differences in the recurrence pattern or progression of HCC at the time of recurrence between the two groups. The only difference in the treatment distribution was the administration of TKIs (14 of 34 patients in afterTKI group and only 1 of 19 patients in beforeTKI group, p < 0.001).ConclusionThese data suggest that TKI therapy for recurrent BCLC‐C HCC is associated with improved overall survival. Thus, LR could be a promising option for BCLC‐C HCC in the current era of TKI therapy.

Improved survival outcome of curative liver resection for Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma in the era of tyrosine kinase inhibitors

Asahi,

Kakisaka,

Kamiyama

et al. 2024

A classification model for resectability in hepatocellular carcinoma patients

Nakamura,

Yoh,

Nishimura

et al. 2024

AimSome patients undergoing liver resection for hepatocellular carcinoma (HCC) have poor outcomes. Therefore, we aimed to propose a new resectability classification for patients with HCC.MethodsWe classified patients into three categories: resectable (R), borderline resectable (BR), and unresectable (UR). Patients (n = 409) who underwent hepatectomy for HCC were assigned to the non‐UR (R and BR classes combined; n = 285) and UR‐HCC classes (n = 68; training cohort). Patient characteristics in the BR‐HCC and R‐HCC groups were compared. The new criteria were tested in a validation cohort (n = 295).ResultsOf the 285 patients, 229 and 56 were classified into the R‐ and BR‐HCC classes, respectively, using macrovascular invasion, tumor size, and future liver remnant/modified albumin‐bilirubin scores. Patients with BR‐HCC demonstrated significantly worse progression‐free and overall survival (p < 0.0001 and p < 0.0001, respectively) than patients with R‐HCC in the training cohort. Similar results were observed in the validation cohort. Multivariate analysis of the non‐UR‐HCC group in the training cohort revealed that the tumor number and BR‐HCC were independent predictive factors for poor overall survival.ConclusionsThis classification can help select patients with BR‐HCC for preoperative treatment before considering surgery.

Newly established borderline resectable 1 (BR1) category is one of the favorable candidates for selecting the use of multidisciplinary combination therapy in patients with advanced hepatocellular carcinoma treated with systemic therapy

Kawamura,

Akuta,

Shindoh

et al. 2024

BackgroundThe aim of this study was to evaluate the newly established oncological criteria of resectability of hepatocellular carcinoma (HCC) for selecting suitable candidates for systemic and combination therapy.MethodsThe data of 156 consecutive HCC patients with intrahepatic target nodules who had initially received systemic therapy (lenvatinib and atezolizumab plus bevacizumab) were reviewed. The patients were classified into three groups according to the novel oncological criteria for resectability (R, resectable; BR1, borderline resectable 1; and BR2, borderline resectable 2). The prognostic ability and clinical utility for selecting this population to receive combined use of multiple systemic sequential and locoregional therapy was then evaluated. Combined use of systemic sequential therapy with more than two agents and locoregional treatment was defined as multidisciplinary combination therapy (MCT), while systemic sequential therapy only and repeated locoregional treatment was defined as a single treatment procedure (STP).ResultsPatients classified as R and BR1 had significantly better overall survival (OS) compared with BR2 (R vs. BR2, p = 0.012; BR1 vs. BR2, p = 0.004). However, there was no significant difference between R and BR1 (p = 1.000), in spite of significantly worse oncological status in the BR1 patients. Following a R0 resection and MCT, the BR1 patients had significantly better OS compared with those receiving STP or no additional treatment (median OS, not reached vs. 25.2 months and 20.1 vs. 11.3 months, respectively; p = 0.034).ConclusionsIn patients with advanced HCC with intrahepatic target nodules the BR1 category is one of the favorable candidates for selecting those to be treated with MCT strategies.