Postoperative outcomes and recurrence patterns of intermediate-stage hepatocellular carcinoma dictated by the sum of tumor size and number.

BACKGROUND

The selection criteria for Barcelona Clinic Liver Cancer (BCLC) intermediate-stage hepatocellular carcinoma (HCC) patients who would truly benefit from liver resection (LR) remain undefined.

AIM

To identify BCLC-B HCC patients more suitable for LR.

METHODS

We included patients undergoing curative LR for BCLC stage A or B multi-nodular HCC (MNHCC) and stratified BCLC-B patients by the sum of tumor size and number (N + S). Overall survival (OS), recurrence-free survival (RFS), recur-rence-to-death survival (RTDS), recurrence patterns, and treatments after recurrence in BCLC-B patients in each subgroup were compared with those in BCLC-A patients.

RESULTS

In total, 143 patients who underwent curative LR for MNHCC with BCLC-A ( = 25) or BCLC-B ( = 118) were retrospectively analyzed. According to the N + S, patients with BCLC-B HCC were divided into two subgroups: BCLC-B1 (N + S ≤ 10, = 83) and BCLC-B2 (N + S > 10, = 35). Compared with BCLC-B2 patients, those with BCLC-B1 had a better OS (5-year OS rate: 67.4% 33.6%; < 0.001), which was comparable to that in BCLC-A patients (5-year OS rate: 67.4% 74.1%; = 0.250), and a better RFS (median RFS: 19 mo 7 mo; < 0.001), which was worse than that in BCLC-A patients (median RFS: 19 mo 48 mo; = 0.022). Further analysis of patients who developed recurrence showed that both BCLC-B1 and BCLC-A patients had better RTDS (median RTDS: Not reached 49 mo; = 0.599), while the RTDS in BCLC-B2 patients was worse (median RTDS: 16 mo not reached, < 0.001; 16 mo 49 mo, = 0.042). The recurrence patterns were similar between BCLC-B1 and BCLC-A patients, but BCLC-B2 patients had a shorter recurrence time and a higher proportion of patients had recurrence with macrovascular invasion and/or extrahepatic metastasis, both of which were independent risk factors for RTDS.

CONCLUSION

BCLC-B HCC patients undergoing hepatectomy with N + S ≤ 10 had mild recurrence patterns and excellent OS similar to those in BCLC-A MNHCC patients, and LR should be considered in these patients.