Liver resection for intermediate hepatocellular carcinoma

Table 1 Studies related to complications of liver resection and transhepatic arterial chemotherapy and embolization for intermediate hepatocellular carcinoma

Ref.	Patient	Median OS	Survival rate	DFS	Hospital mortality	Complications
Wang et al[24]	LR: 243	LR: 60.4	1-, 3- and 5-yr	NR	NR	NR
	TACE: 741	TACE: 18.2	LR: 81.5%, 64.4%, 50.5%
		Sig	TACE: 61.9%, 29.1%, 16.4%
			Sig
Ho et al[25]	LR: 122	LR: 41.8	1-, 3- and 5-yr	1-, 3- and 5-yr	NR	NR
	TACE: 163	TACE: 16.8	LR: 77.4%, 51.9%, 36.6%	LR: 60.5%, 32.3%, 24.8%
		Sig	TACE: 62.6%, 25.2%, 11%
			Sig
Lin et al[26]	LR: 93	LR: 27.6	1-, 2- and 3-yr	NR	LR: 3/78 (3.8%)	NR
	TACE: 73	TACE: 18.5	LR: 83%, 62%, 49%		TACE: 5/93 (5.4%)
			TACE: 39%, 5%, 2%		No sig
			Sig
Hsu et al[27]	LR: 268	NR	1-, 3- and 5-yr	NR	90 d	LR vs TACE:
	TACE: 455		LR: 81%, 68%, 63%		LR: 4/146 (2.7%)	Acute liver failure (20% vs 11%)
			TACE: 30%, 43%, 15%		TACE: 12/146 (8.2%)	Sig
			Sig		Sig	Biliary tract injury (6.8% vs 0%)
						Sig
Zhong et al[28]	LR: 660	NR	1-, 3- and 5-yr	NR	NR	NR
	TACE: 319		LR: 91%, 67%, 44%
			TACE: 83%, 35%, 17%
			Sig
Zhong et al[29]	LR: 257	LR: 42.9	1-, 3- and 5-yr	NR	LR vs TACE: 3.1% vs 3.7%	LR vs TACE: 28% vs 18.5%
	TACE: 135	TACE: 21	LR: 84%, 59%, 37%		No sig	Sig
		Sig	TACE: 69%, 29%, 14%
			Sig
			After propensity score analysis
			LR: 87%, 62%, 35%
			TACE: 77%, 44%, 20%
			Sig
Yin et al[31]	LR: 88	LR: 41	1-, 2- and 3-yr	NR	LR: 1/88 (1.1%)	NR
	TACE: 85	TACE: 14	LR: 76.1%, 63.5%, 51.5%
		Sig	TACE: 51.8%, 34.8%, 18.1%
			Sig

NR: Not reported; OS: Overall survival; DFS: Disease-free survival; Sig: Significant difference; LR: Patients with liver resection; TACE: Patients with trans-catheter arterial chemoembolization.

Table 2 Studies comparing liver resection for Barcelona Clinic Liver Cancer A and B

Ref.	Group	Median OS (mo)	Median DFS (mo)	Accumulative DFS	Intrahepatic recurrence	Extra-hepatic recurrence	Survival rate	Mortality	Morbidity
Ng et al[38]	BCLC A: 404	A: 83.5 (67.9-99.1)	A: 77 (66, 87.9)	A: 80%, 64%, 40%	A: 139/404 (34.4%)	A: 95/404 (23.5%)	1-, 3- and 5- yr	A: 11/404 (2.7%)	93/404 (23.0%)
	BCLC B: 380	B: 36.9 (28.9-44.8)	B: 15.6 (10.8-20.4)	B: 54%, 38%, 26%	B: 199/380 (52.4%)	B: 110/380 (29.0%)	A: 88%, 76%, 58%	B: 9/380 (2.4%)	104/380 (27.4%)
		Sig	Sig	Sig	Sig	No sig	B: 74%, 50%, 39%	No sig	No sig
							Sig
Cho et al[39]	BCLC A: 169	NR	NR	1-, 3- and 5- yr	NR	NR	1-, 3- and 5- yr	A: 1/169 (0.6%)	NR
	BCLC B: 61			A: 71.4%, 51.8%, 44.1%			A: 87.5%, 69.5%, 59.0%	B: 1/61 (1.6%)
				B: 58.3%, 40.0%, 31.7%			B: 85.0%, 59.3%, 52.9%	No sig
				No sig			No sig
Torzilli et al[44]	BCLC A: 61	NR	NR	A: 77%, 30%	A: 19/61 (31.14%)	A: 2/61 (3.3%)	1- and 3-yr	A: 0	A: 13/61 (21.3%)
	BCLC B: 24			B: 75%, 35%	B: 6/24 (25%)	B: 3/24 (12.5%)	A: 91.6%, 81%	B: 0	B: 7/24 (29.2%)
				No sig	No sig	No sig	B: 85%, 67%	No sig	No sig
							No sig
Wang et al[24]	BCLC A: 202	A: Can’t estimate	A: NR	A: NR	A: NR	A: NR	A: Cannot be estimated	NR	NR
	BCLC B: 243	B: 60.4	B: NR	B: NR	B: NR	B: NR	B: 1-, 3- and 5- yr
							(81.5%, 64.4%, 50.5%)
Wei et al[40]	BCLC A: 52	NR	NR	1-, 2- and 3-yr	NR	NR	1-, 2- and 3-yr	NR	NR
	BCLC: 51			A: 77.8%, 61.4%, 48.9%			A: 86.5%, 75.0%, 69.2%
				B: 70.2%, 55.8%, 45.4%;			B: 84.3%, 68.6%, 54.9%
				No sig			No sig
Chang et al[43]	BCLC A: NR	NR	NR	5 yr	The 1-, 2-, 3- and 5-yr recurrence rates were 44.2%, 54.5%, 60.6%, and 68.1%, respectively, in BCLC stage B patients		1-, 2-, 3- and 5-yr	NR	NR
	BCLC B: 318			B: 28.6%			B: 81.2%, 68.1%, 59.4%, 46.5%
Ma et al[49]	BCLC A: 92	A: Cannot be estimated	A: Cannot be estimated	NR	NR	NR	NR	NR	NR
	BCLC B: 178	B: 27.9 ± 3.1 (21.8-33.9)	B: 16.8 ± 1.65 (13.6-20.0)
Torzilli et al[41]	BCLC A: 777	NR	NR	1-, 3- and 5-yr	NR	NR	1-, 3- and 5-yr	30 d	Not significant in major complications
	BCLC B: 633			A: 77%, 41%, 21%			A: 9 5%, 80%, 61%	A: 1.6% vs B: 3.1%
				B: 63%, 38%, 27%			B: 88%, 71%, 57%	No sig
				Sig			Sig
Cucchetti et al[35]	BCLC A: NR	B: 35 (26-42)	NR	NR	NR	NR	1-, 3- and 5-yr	NR	NR
	BCLC B: 247						B: 77.8%, 48.7% 33.8%
Yamashita [42]	BCLC A: Cannot be estimated	NR	NR	5-yr	Recurrence rate		5 yr	B: 2/53 (3.8%)	B: 13/53 (24.5%)
	BCLC B: 53			B: 24%	B: 32/53 (62%)		B: 35%

OS: Overall survival; DFS: Disease-free survival; A: Patients with HCC of BCLC A; B: Patients with HCC of BCLC B; NR: Not reported; HCC: Hepatocellular carcinoma; BCLC: Barcelona Clinic Liver Cancer; Sig: Significant difference.

Table 3 Prognostic risk factors of overall survival and disease-free survival

Ref.	Prognostic factors of overall survival		Prognostic factors of disease-free survival
	By univariate analysis	By multivariate analysis	By univariate analysis	By multivariate analysis
Ng et al[38]	Hepatitis B surface antigen carrier, serum AFP, symptomatic disease, presence of cirrhosis, number of tumor nodule, microvascular tumor invasion, tumor invasion of adjacent organs, histological margin involvement by tumor	Symptomatic disease, presence of cirrhosis, multi-nodular tumor, microvascular tumor invasion, positive histological margin	Serum AFP level, symptomatic disease, presence of cirrhosis, multi-nodular tumor, microvascular tumor invasion, tumor invasion of adjacent organ, positive histological margins, the presence of microsatellite nodules	Symptomatic disease, presence of cirrhosis, multi-nodular tumor, positive histological margins
Torzilli et al[44]	Tumor size, tumor grade	Tumor size, tumor grade	NR	NR
Chang et al[43]	NR	Serum albumin level, ICG-15R, serum creatinine, multi-nodularity, Edmondson stage, macro-vascular invasion	NR	NR
Ma et al[49]	Histopathological grade, tumor capsule, tumor number, cirrhosis, BCLC classification	Tumor capsule, BCLC classification	NR	Tumor capsule, BCLC classification
Torzilli et al[41]	Tumor number, tumor size, macro-vascular invasion, presence of cirrhosis, esophageal varices, major resection, BCLC classification, preoperative bilirubin values	NR	NR	NR
Cucchetti et al[35]	NR	Tumor number, presence of esophageal varices, Child-Pugh score	NR	NR
Cho et al[39]	Child-Pugh class B, AFP level > 400 ng/mL, histologically poor differentiation	Child-Pugh class B	Positivity of hepatitis B surface antigen, Child-Pugh class B, AFP level > 400 ng/mL, microvascular invasion, histologically poor differentiation	Child-Pugh class B, microvascular invasion
Yamashita et al[42]	NR	T4 status of HCC stage by liver cancer study group of Japan, thrombus in portal vein	NR	T4 status of HCC stage by liver cancer study group of Japan, intra-operative transfusion
Lin et al[26]	NR	Low albumin level, treatment modality (liver resection vs TACE)	NR	NR
Hsu et al[27]	NR	Serum AFP level, Child-Pugh class B, performance status ≥ 2, TACE, tumor size, vascular invasion	NR	NR
Zhong et al[28]	NR	Serum AFP ≥ 400 ng/mL, diabetes mellitus, macro-vascular invasion, portal hypertension, TACE treatment	NR	NR
Yin et al[31]	Treatment modality, serum AFP level, total tumor size, tumor number, gender	Tumor number, treatment modality, gender	NR	NR

TACE: Transhepatic arterial chemotherapy and embolization; NR: Not reported; HCC: Hepatocellular carcinoma; BCLC: Barcelona Clinic Liver Cancer; AFP: Alpha fetoprotein.