Barros Andrea Zaidan de Almeida, Fonseca Gilton Marques, Kruger Jaime Arthur Pirola, Coelho Fabricio Ferreira, Herman Paulo
Liver Surgery Unit, Hospital das Clinicas, University of Sao Paulo School of Medicine, São Paulo, Brazil.
J Gastrointest Oncol. 2022 Dec;13(6):3123-3134. doi: 10.21037/jgo-22-833.
Barcelona Clinic Liver Cancer (BCLC) is a recognized guideline to standardize treatment allocation for hepatocellular carcinoma (HCC); however, many centers criticize its restrictive liver resection recommendations and have published good results after more liberal hepatectomy indications. The objective is to evaluate the results of HCC resection in a single center, with a more liberal indication for resection than proposed by the BCLC guideline. It was performed a retrospective cohort study including all patients who underwent liver resection for HCC in a single center between April 2008 and November 2018.
The results of 150 patients who underwent hepatectomy were evaluated and compared facing both 2010 and 2018 BCLC guidelines. Overall and disease-free survival after resection in patients with none, one, two, or three of the risk factors, as proposed by the BCLC, as contraindications to resection (portal hypertension, portal invasion, and more than one nodule) were analyzed.
Nodule size and presence of portal invasion alone did not affect prognosis. If the BCLC 2010 and 2018 guidelines were followed, 46.7% and 26.7% of the patients, respectively, would not have received potentially curative treatment. The median overall and disease-free survival for patients with one BCLC contraindication factor were 43.3 and 15.1 months, respectively. The presence of two risk factors had a negative impact on overall survival (OS) and disease-free survival (DFS), although some patients had long-term survival. The only patient with the three risk factors had a poor outcome.
Selected patients with one BCLC contraindication factor may undergo resection with good results, whereas those with two factors should be allocated for hepatectomy only in favorable scenarios. Patients with the three risk factors do not appear to benefit from resection.
巴塞罗那临床肝癌（BCLC）是一项公认的用于规范肝细胞癌（HCC）治疗分配的指南；然而，许多中心批评其肝脏切除建议过于严格，并且在采用更宽松的肝切除指征后公布了良好的结果。目的是评估在单一中心进行肝癌切除的结果，该中心的肝切除指征比BCLC指南所建议的更为宽松。进行了一项回顾性队列研究，纳入了2008年4月至2018年11月期间在单一中心接受肝癌肝切除的所有患者。
评估并比较了150例行肝切除术患者的结果，同时参照2010年和2018年的BCLC指南。分析了根据BCLC提出的作为切除禁忌证（门静脉高压、门静脉侵犯和多个结节）的无、一、二或三个危险因素的患者切除术后的总生存期和无病生存期。
仅结节大小和门静脉侵犯的存在并不影响预后。如果遵循BCLC 2010年和2018年指南，分别有46.7%和26.7%的患者不会接受潜在的根治性治疗。具有一个BCLC禁忌证因素的患者的中位总生存期和无病生存期分别为43.3个月和15.1个月。存在两个危险因素对总生存期（OS）和无病生存期（DFS）有负面影响，尽管一些患者有长期生存。唯一具有三个危险因素的患者预后较差。
部分具有一个BCLC禁忌证因素的患者可接受切除，结果良好，而具有两个因素的患者仅在有利情况下才应进行肝切除术。具有三个危险因素的患者似乎无法从切除术中获益。
