Diamantis I Tsilimigras1, Fabio Bagante1,2, Kota Sahara1, Dimitrios Moris1, J Madison Hyer1, Lu Wu1, Francesca Ratti3, Hugo P Marques4, Olivier Soubrane5, Anghela Z Paredes1, Vincent Lam6, George A Poultsides7, Irinel Popescu8, Sorin Alexandrescu8, Guillaume Martel9, Aklile Workneh9, Alfredo Guglielmi2, Tom Hugh10, Luca Aldrighetti3, Itaru Endo11, Timothy M Pawlik12. 1. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 2. Department of Surgery, University of Verona, Verona, Italy. 3. Department of Surgery, Ospedale San Raffaele, Milan, Italy. 4. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal. 5. Department of Hepatobiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France. 6. Department of Surgery, Westmead Hospital, Sydney, NSW, Australia. 7. Department of Surgery, Stanford University, Stanford, CA, USA. 8. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania. 9. Department of Surgery, University of Ottawa, Ottawa, ON, Canada. 10. Department of Surgery, The University of Sydney, School of Medicine, Sydney, NSW, Australia. 11. Yokohama City University School of Medicine, Yokohama, Japan. 12. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. tim.pawlik@osumc.edu.
Abstract
BACKGROUND: Although the Barcelona Clinic Liver Cancer (BCLC) staging system has been largely adopted in clinical practice, recent studies have questioned the prognostic stratification of this classification schema, as well as the proposed treatment allocation of patients with a single large tumor. METHODS: Patients who underwent curative-intent hepatectomy for histologically proven hepatocellular carcinoma (HCC) between 1998 and 2017 were identified using an international multi-institutional database. Overall survival (OS) among patients with BCLC stage 0, A, and B was examined. Patients with a single large tumor were classified as BCLC stage A1 and were independently assessed. RESULTS: Among 814 patients, 68 (8.4%) were BCLC-0, 310 (38.1%) were BCLC-A, 279 (34.3%) were BCLC-A1, and 157 (19.3%) were BCLC-B. Five-year OS among patients with BCLC stage 0, A, A1, and B HCC was 86.2%, 69.0%, 56.9%, and 49.9%, respectively (p < 0.001). Among patients with very early- and early-stage HCC (BCLC 0, A, and A1), patients with BCLC stage A1 had the worst OS (p = 0.0016). No difference in survival was noted among patients undergoing surgery for BCLC stage A1 and B HCC (5-year OS: 56.9% vs. 49.9%; p = 0.259) even after adjusting for competing factors (hazard ratio 0.83, 95% confidence interval 0.54-1.28; p = 0.40). CONCLUSION: Prognosis following liver resection among patients with BCLC-A1 HCC was similar to patients presenting with BCLC-B tumors. Surgery provided acceptable long-term outcomes among select patients with BCLC-B HCC. Designation into BCLC stage B should not be considered an a priori contraindication to surgery.
BACKGROUND: Although the Barcelona Clinic Liver Cancer (BCLC) staging system has been largely adopted in clinical practice, recent studies have questioned the prognostic stratification of this classification schema, as well as the proposed treatment allocation of patients with a single large tumor. METHODS:Patients who underwent curative-intent hepatectomy for histologically proven hepatocellular carcinoma (HCC) between 1998 and 2017 were identified using an international multi-institutional database. Overall survival (OS) among patients with BCLC stage 0, A, and B was examined. Patients with a single large tumor were classified as BCLC stage A1 and were independently assessed. RESULTS: Among 814 patients, 68 (8.4%) were BCLC-0, 310 (38.1%) were BCLC-A, 279 (34.3%) were BCLC-A1, and 157 (19.3%) were BCLC-B. Five-year OS among patients with BCLC stage 0, A, A1, and B HCC was 86.2%, 69.0%, 56.9%, and 49.9%, respectively (p < 0.001). Among patients with very early- and early-stage HCC (BCLC 0, A, and A1), patients with BCLC stage A1 had the worst OS (p = 0.0016). No difference in survival was noted among patients undergoing surgery for BCLC stage A1 and B HCC (5-year OS: 56.9% vs. 49.9%; p = 0.259) even after adjusting for competing factors (hazard ratio 0.83, 95% confidence interval 0.54-1.28; p = 0.40). CONCLUSION: Prognosis following liver resection among patients with BCLC-A1 HCC was similar to patients presenting with BCLC-B tumors. Surgery provided acceptable long-term outcomes among select patients with BCLC-B HCC. Designation into BCLC stage B should not be considered an a priori contraindication to surgery.
Authors: John R Bergquist; Amy Y Li; Chris S Javadi; Ranjit S Chima; Joseph S Frye; Brendan C Visser Journal: Dig Dis Sci Date: 2020-11-03 Impact factor: 3.199
Authors: Jeong Hee Yoon; Jeong Min Lee; Dong Ho Lee; Ijin Joo; Ju Hyun Jeon; Su Joa Ahn; Seung-Taek Kim; Eun Ju Cho; Jeong-Hoon Lee; Su Jong Yu; Yoon Jun Kim; Jung-Hwan Yoon Journal: Liver Cancer Date: 2020-08-06 Impact factor: 11.740
Authors: S Bennett; K Søreide; S Gholami; P Pessaux; C Teh; E Segelov; H Kennecke; H Prenen; S Myrehaug; D Callegaro; J Hallet Journal: Curr Oncol Date: 2020-10-01 Impact factor: 3.677