Cancer Res Treat.  2019 Jan;51(1):65-72. 10.4143/crt.2018.038.

Hepatic Resection Provides Survival Benefit for Selected Intermediate-Stage (BCLC-B) Hepatocellular Carcinoma Patients

• Zhaohui Z
• Shunli S
• Bin C
• Shaoqiang
• Yunpeng H
• Ming K
• Lijian L
• Gang PB

• KMID: 2437599
• DOI: http://doi.org/10.4143/crt.2018.038

Abstract

PURPOSE
The intermediate stage of hepatocellular carcinoma (HCC) (Barcelona Clinic Liver Cancer [BCLC] B) comprises a highly heterogeneous population, and the treatment strategy is still controversial. Because of the heterogeneity, a subclassification of intermediate-stage HCCs was put forward by Bolondi according to the "˜beyond Milan and within up-to-7' criteria and Child-Pugh score. In this study, we aim to analyze the prognosis of BCLC-B stage HCC patients who received hepatic resection according to the Bolondi's subclassification.
MATERIALS AND METHODS
One thousand and one hundred three patients diagnosedwith HCC and treatedwith hepatic resectionwere enrolled in our hospital between 2006 and 2012. According to Bolondi's subclassification, the BCLC-B patients were divided into four groups. Recurrence-free survival (RFS) and overall survival (OS) were analyzed.
RESULTS
According to Bolondi's subclassification, the BCLC-B patients were divided into four groups: B1 (n=41, 18.7%), B2 (n=160, 73.1%), B3 (n=11, 5.0%), and B4 (n=7, 3.2%). Significant difference was observed between B1 and other groups (B1 vs. B2, p=0.022; B1 vs. B3, p < 0.001; B1 vs. B4, p < 0.001), but no difference for B2 vs. B4 (p=0.542) and B3 vs. B4 (p=0.542). In addition, no significant differences were observed between BCLC-A and BCLC-B1 group for both RFS (p=0.087) and OS (p=0.643). In multivariate analysis, BCLC-B subclassification was not a risk factor for both OS (p=0.263) and RFS (p=0.892).
CONCLUSION
In our study, HCC patients at B1 stagewere benefited from hepatic resection and had similar survival to BCLC-A stage patients. Our study provided rationality of hepatic resection for selected BCLC-B stage HCC patients instead of routine transarterial chemoembolization.

Keyword

Hepatocellular carcinoma; Hepatectomy; Barcelona Clinic Liver Cancer; Bolondi's subclassification

MeSH Terms

Carcinoma, Hepatocellular*
Hepatectomy
Humans
Liver Neoplasms
Multivariate Analysis
Population Characteristics
Prognosis
Risk Factors

Figure

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  Fig. 1. (A) Overall survival according to the Barcelona Clinic Liver Cancer (BCLC) staging system. (B) Recurrence-free survival according to the BCLC staging system. (C) Overall survival of BCLC-A and BCLC-B1. (D) Recurrence-free survival of BCLC-A and BCLC-B1.

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  Fig. 2. (A) Overall survival according to the Bolondi’s classification. (B) Recurrence-free survival according to the Bolondi’s classification. (C) Overall survival according to the modified Bolondi’s classification (Kinki criteria). (D) Recurrence-free survival according to the modified Bolondi’s classification (Kinki criteria).

Reference

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