J Liver Cancer.  2023 Sep;23(2):377-388. 10.17998/jlc.2023.08.24.

Clinical outcome of surgical resection for multifocal T2-T3 hepatocellular carcinoma up to 3 nodules: a comparative analysis with a single nodule

• Yu S
• Jo HS
• Yu YD
• Choi Yj
• Kim DS

• KMID: 2546417
• DOI: http://doi.org/10.17998/jlc.2023.08.24

Abstract

Background/Aims
Although the Barcelona Clinic Liver Cancer staging system seems to underestimate the impact of curative-intent surgical resection for multifocal hepatocellular carcinoma (HCC), recent studies have indicated favorable results for the surgical resection of multiple HCC. This study aimed to assess clinical outcomes and feasibility of surgical resection for multifocal HCC with up to three nodules compared with single tumor cases.
Methods
Patients who underwent surgical resection for HCC with up to three nodules between 2009 and 2020 were included, and those with the American Joint Committee on Cancer (AJCC) 8th edition, T1 and T4 stages were excluded to reduce differences in disease distribution and severity. Finally, 81 and 52 patients were included in the single and multiple treatment groups, respectively. Short- and long-term outcomes including recurrence-free survival (RFS) and overall survival (OS), were evaluated.
Results
All patients were classified as Child-Pugh class A. RFS and OS were not significantly different between the two groups (P=0.176 and P=0.966, respectively). Multivariate analysis revealed that transfusion and intrahepatic metastasis were significantly associated with recurrence (P=0.046 and P=0.005, respectively). Additionally, intrahepatic metastasis was significantly associated with OS (hazard ratio, 1.989; 95% confidence interval, 1.040-3.802; P=0.038).
Conclusions
Since there was no significant difference in survival between the single and multiple groups among patients with AJCC 8th stage T2 and T3, surgical resection with curative intent could be considered with acceptable long-term survival for selected patients with multiple HCC of up to three nodules.

Keyword

Carcinoma, hepatocellular; Hepatectomy; Treatment outcome

Figure

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  Figure 1. Patients’ selection and study design. HCC, hepatocellular carcinoma; RFA, radiofrequency ablation; AJCC, American Joint Committee on Cancer.

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  Figure 2. Long-term outcomes of single and multiple groups. (A) Recurrence-free survival and (B) overall survival between the groups.

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  Figure 3. Long-term outcomes of single and multiple groups classified by pathological examination results. (A) Recurrence-free survival and (B) overall survival between the groups.

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Reference

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