Prognosis after resection of single large hepatocellular carcinoma: Results from an Asian high-volume liver surgery center

Abstract

Background & aims In 2012, the Barcelona Clinic Liver Cancer (BCLC) system designated a single large hepatocellular carcinoma (SLHCC) (>5 cm) as BCLC stage A rather than stage B. However, a recent study from western countries reported that prognosis following liver resection (LR) among patients with SLHCC was similar to that among patients with BCLC stage B. We aim to evaluate the prognosis following LR among patients with SLHCC from an Asian high-volume liver surgery center. Methods Patients who underwent curative-intent LR for histologically proven HCC between 2011 and 2017 were enrolled using an HCC registry database. Overall survival (OS) among patients with BCLC stages 0, A, and B was examined. Patients with a SLHCC were classified as BCLC stage A1. Results Among 543 patients, 89 (16.4%) were BCLC stage 0, 289 (53.2%) were BCLC stage A, 92 (16.9%) were BCLC stage A1, and 73 (13.4%) were BCLC stage B. The median follow-up was 38 months. The five-year OS rates among patients with BCLC stages 0, A, A1, and B were 83.5%, 83.7%, 77.4%, and 55.4%, respectively (p<0.001). No difference in OS was noted for patients with BCLC stage A versus A1 (p = 0.11), even after adjusting for competing factors (hazard ratio = 0.97, 95% confidence interval = 0.53-1.79; p = 0.93). Conclusion Prognosis following LR among patients with SLHCC was similar to that among patients with BCLC stage A. The prognosis for SLHCC should thus be considered comparable to that for BCLC stage A.

Single Large Nodule (>5 cm) Prognosis in Hepatocellular Carcinoma: Kinship with Barcelona Clinic Liver Cancer (BCLC) Stage A or B?

“…In addition, surgical resection has also been questioned, as a single large tumor is always associated with a high recurrence rate and worse survival. However, consistent with the current study, more and more studies have demonstrated improved survival of these patients after surgical resection vs. TACE or palliative treatments [ 26 – 28 ]. Taken together, data from the current study also strongly advocate surgical resection as the first-line treatment for patients with a single HCC >5 cm.…”

Clinical prognosis of surgical resection versus transarterial chemoembolization for single large hepatocellular carcinoma (≥5 cm): A propensity score matching analysis

“…Previous studies reported that patients receiving SR had better OS rates than those receiving TACE in BCLC stage B HCC patients 8,25 . Recent, several studies showed survival benefit of liver resection for BCLC stage B HCC patients 16,17,23,24,26–29 . Moreover, our study is also consistent with previous study demonstrating that SR was significantly associated with better OS and PFS than TACE 12 …”

Adherence to the modified Barcelona Clinic Liver Cancer guidelines: Results from a high-volume liver surgery center in East Asias

“…A significant proportion of patients in the present study underwent LR because HBV is the leading etiology of HCC in Taiwan and a higher proportion of the patients had HBV–associated non-cirrhotic HCC. Our previous study found that around 60% of patients with HCC who underwent LR were non-cirrhotic [ 26 ]. Major liver resections can be performed with low rates of major complications in non-cirrhotic patients [ 6 ].…”