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Postoperative outcomes and recurrence patterns of intermediate-stage hepatocellular carcinoma dictated by the sum of tumor size and number
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 st...
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Published in: | World journal of gastroenterology : WJG 2022-11, Vol.28 (44), p.6271-6281 |
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Main Authors: | , , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that this one cites Items that cite this one |
Online Access: | Get full text |
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Summary: | 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. |
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ISSN: | 1007-9327 2219-2840 |
DOI: | 10.3748/wjg.v28.i44.6271 |