Survival outcomes of hepatectomy for stage B Hepatocellular carcinoma in the BCLC classification

Abstract

BackgroundBecause hepatectomy is not recommended in patients with stage B hepatocellular carcinoma (HCC) of the Barcelona Clinic Liver Cancer (BCLC) staging, we evaluated the survival outcomes of hepatectomy for stage B in the BCLC system.MethodsData were collected from 297 consecutive adult stage B patients who underwent curative hepatectomy for HCC between 1996 and 2014 in Hokkaido University Hospital. Overall survival (OS), disease-free survival (DFS), and risk factors were analyzed using the Kaplan–Meier method. Independent prognostic factors were evaluated using a Cox proportional hazards regression model. AP-factor (alpha-fetoprotein [AFP] × protein induced by vitamin K absence or antagonism factor II [PIVKA-II]) was categorized according to the serum concentrations of AFP and PIVKA-II: AP1 (AFP < 200 ng/ml and PIVKA-II < 100 mAU/ml), AP2 (AFP × PIVKA-II < 105), and AP3 (AFP × PIVKA-II ≥ 105).ResultsThere were 130 deaths among our 297 stage B patients (43.8%). The causes of death in these cases were HCC recurrence (n = 106; 81.5%), liver failure (n = 7; 5.4%), and other causes (n = 17; 16.1%). The operative mortality rate was 0.34% (1/297). The 5-year OS and DFS rates for the stage B cases were 54.3 and 21.9%, respectively. By multivariate analysis, tumor number and AP-factor were risk factors for both survival and recurrence that were tumor related and could be evaluated preoperatively. The study patients with stage B HCC were classified into three groups by tumor number (B1, 1; B23, 2 or 3; B4over: ≥4) and into three groups stratified by AP-factor (AP1, AP2, and AP3). The 5-year OS rates of B1, B23, and B4over were 63.6, 52.3, and 29.0%. The 5-year OS rates of AP1, AP2, and AP3 were 67.6, 65.2, and 39.1%. Stratified by the 5-year OS rate, stage B HCC patients were classified into three subgroups (A-C).The 5-year OS rates of groups A (B1 or B23 and AP-1 or AP-2), B (B1 or B23 and AP-3, or B4over and AP-1 or AP-2), and C (B4over and AP-3) were 69.5, 43.7, and 21.3%.ConclusionStage B HCC patients with a tumor number ≤ 3 and/or AP-factor < 1 × 105 show acceptable 5-year OS rates and could be treated by hepatectomy.

Comprehensive investigation of p53, p21, nm23, and VEGF expression in hepatitis B virus-related hepatocellular carcinoma overall survival after hepatectomy

“…AFP was not a strong prognostic marker despite the fact that serum AFP level above 400 ng/ml would indicate poor overall survival time after hepatectomy in patients with HBV-associated HCC [38]. Some studies reported that combined analysis enhanced diagnosis and prognosis value of AFP in HCC [39,40]. Our results suggested joint analysis of AFP, p53 and VEGF might be performed for the prediction of the clinical outcomes of HBV-related HCC patients in Guangxi.…”

<p>High Inflammatory Factor Grading Predicts Poor Disease-Free Survival in AJCC Stage I-II Hepatocellular Carcinoma Patients After R0 Resection</p>

“…The clinical grading systems for HCC prognosis include Barcelona clinic liver cancer (BCLC) staging, 11 Okuda staging, 12 tumor-node-metastasis (TNM) staging, 13 and albumin-bilirubin (ALBI) grading, 14 and they consider factors such as tumor size, number of lesions, vascular invasion, extrahepatic metastases, and common clinical and pathological factors such as Child-Pugh classification. However, none of these grading systems take into account the inflammatory status of the tumor microenvironment.…”

Comparison of hepatic resection and transarterial chemoembolization for UICC stage T3 hepatocellular carcinoma: a propensity score matching study

“…Surgical resection was recognized as the last but not least option for these patients to obtain long-term survival [ 2 , 3 , 5 , 6 ]. Several studies have reported that radical resection of the tumor and involved vessels can prolong survival and may eventually offer a chance of cure in selected cases [ 3 , 12 , 24 , 25 ]. However, even in these areas, there is still controversy over optimum treatment strategy for HCC patients in these stage, regardless guidelines for practice.…”

“…Until now, there have been several studies and meta-analysis accessing HR and TACE in the management of intermediate or advanced stage of HCC [ 25 , 40 – 44 ]. However, to our knowledge, the study we presented here was one of the several studies to access the survival outcome of HR versus TACE in UICC/AJCC stage IIIa/IIIb HCC patients [ 12 , 45 , 46 ].…”