Hepatic Surgery Center, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China.
World J Gastroenterol. 2022 Nov 28;28(44):6271-6281. doi: 10.3748/wjg.v28.i44.6271.
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.
To identify BCLC-B HCC patients more suitable for LR.
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.
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.
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.
巴塞罗那临床肝癌（BCLC）中期肝细胞癌（HCC）患者中，真正受益于肝切除术（LR）的选择标准仍未确定。
确定更适合 LR 的 BCLC-B HCC 患者。
我们纳入了接受 BCLC 分期 A 或 B 多结节 HCC（MNHCC）根治性 LR 的患者，并根据肿瘤大小和数量之和（N+S）对 BCLC-B 患者进行分层。比较每个亚组中 BCLC-B 患者的总生存期（OS）、无复发生存期（RFS）、复发至死亡生存期（RTDS）、复发模式和复发后的治疗。
共回顾性分析了 143 例接受 MNHCC 根治性 LR 的患者，其中 BCLC-A（=25）或 BCLC-B（=118）。根据 N+S，BCLC-B HCC 患者分为两组：BCLC-B1（N+S≤10，=83）和 BCLC-B2（N+S>10，=35）。与 BCLC-B2 患者相比，BCLC-B1 患者的 OS 更好（5 年 OS 率：67.4% 33.6%；<0.001），与 BCLC-A 患者相当（5 年 OS 率：67.4% 74.1%；=0.250），RFS 更好（中位 RFS：19 个月 7 个月；<0.001），但不如 BCLC-A 患者（中位 RFS：19 个月 48 个月；=0.022）。对发生复发的患者进行进一步分析显示，BCLC-B1 和 BCLC-A 患者均具有更好的 RTDS（中位 RTDS：未达到 49 个月；=0.599），而 BCLC-B2 患者的 RTDS 更差（中位 RTDS：16 个月 未达到，<0.001；16 个月 49 个月，=0.042）。BCLC-B1 和 BCLC-A 患者的复发模式相似，但 BCLC-B2 患者的复发时间更短，且更有发生大血管侵犯和/或肝外转移的比例更高，这两者都是 RTDS 的独立危险因素。
N+S≤10 的 BCLC-B HCC 患者行肝切除术具有轻微的复发模式和与 BCLC-A MNHCC 患者相似的优异 OS，应考虑在这些患者中进行 LR。
