Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2022; 28(44): 6271-6281
Published online Nov 28, 2022. doi: 10.3748/wjg.v28.i44.6271
Postoperative outcomes and recurrence patterns of intermediate-stage hepatocellular carcinoma dictated by the sum of tumor size and number
Xin-Sheng Hu, Hui-Yuan Yang, Chao Leng, Zhi-Wei Zhang
Xin-Sheng Hu, Hui-Yuan Yang, Chao Leng, Zhi-Wei Zhang, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Author contributions: Hu XS performed the research and wrote the paper; Yang HY performed the follow-up; Leng C designed the research and supervised the report; Zhang ZW provided clinical advice and supervised the report; and all authors read and approved the final version.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology (Approval No. TJ-IRB20210918).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chao Leng, PhD, Doctor, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan 430030, Hubei Province, China. lengchaojdld@163.com
Received: August 6, 2022
Peer-review started: August 6, 2022
First decision: September 26, 2022
Revised: October 9, 2022
Accepted: November 9, 2022
Article in press: November 9, 2022
Published online: November 28, 2022
Processing time: 110 Days and 9 Hours
Abstract
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 (n = 25) or BCLC-B (n = 118) were retrospectively analyzed. According to the N + S, patients with BCLC-B HCC were divided into two subgroups: BCLC-B1 (N + S ≤ 10, n = 83) and BCLC-B2 (N + S > 10, n = 35). Compared with BCLC-B2 patients, those with BCLC-B1 had a better OS (5-year OS rate: 67.4% vs 33.6%; P < 0.001), which was comparable to that in BCLC-A patients (5-year OS rate: 67.4% vs 74.1%; P = 0.250), and a better RFS (median RFS: 19 mo vs 7 mo; P < 0.001), which was worse than that in BCLC-A patients (median RFS: 19 mo vs 48 mo; P = 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 vs 49 mo; P = 0.599), while the RTDS in BCLC-B2 patients was worse (median RTDS: 16 mo vs not reached, P < 0.001; 16 mo vs 49 mo, P = 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.

Keywords: Hepatocellular carcinoma; Multinodular; Intermediate-stage; Liver resection; Recurrence pattern; Prognosis

Core Tip: Subgroups of Barcelona Clinic Liver Cancer (BCLC) intermediate-stage hepatocellular carcinoma (HCC) patients who would truly benefit from liver resection (LR) remain undefined. We demonstrated that the sum of tumor size and number (N + S) can predict not only prognosis in BCLC-B patients undergoing LR, but also the recurrence patterns and recurrence-to-death survival (RTDS) in these patients. In addition, we indicated that BCLC-B patients undergoing hepatectomy with N + S ≤ 10 had mild recurrence patterns, good RTDS and excellent overall survival similar to those in BCLC-A multinodular HCC patients. The results of this study are helpful in selecting BCLC-B patients more suitable for LR.