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Annals of Surgical Oncology

, Volume 26, Issue 11, pp 3693–3700 | Cite as

Prognosis After Resection of Barcelona Clinic Liver Cancer (BCLC) Stage 0, A, and B Hepatocellular Carcinoma: A Comprehensive Assessment of the Current BCLC Classification

  • Diamantis I. Tsilimigras
  • Fabio Bagante
  • Kota Sahara
  • Dimitrios Moris
  • J. Madison Hyer
  • Lu Wu
  • Francesca Ratti
  • Hugo P. Marques
  • Olivier Soubrane
  • Anghela Z. Paredes
  • Vincent Lam
  • George A. Poultsides
  • Irinel Popescu
  • Sorin Alexandrescu
  • Guillaume Martel
  • Aklile Workneh
  • Alfredo Guglielmi
  • Tom Hugh
  • Luca Aldrighetti
  • Itaru Endo
  • Timothy M. PawlikEmail author
Hepatobiliary Tumors

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.

Notes

Disclosure

The authors declare that they have no conflict of interest.

Supplementary material

10434_2019_7580_MOESM1_ESM.docx (18 kb)
Supplementary material 1 (DOCX 17 kb)

References

  1. 1.
    Beal EW, Tumin D, Kabir A, et al. Trends in the mortality of hepatocellular carcinoma in the United States. J Gastrointest Surg. 2017;21(12):2033–2038.CrossRefGoogle Scholar
  2. 2.
    European Association for the Study of the Liver. EASL Clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182–236.CrossRefGoogle Scholar
  3. 3.
    Marrero JA, Kulik LM, Sirlin CB, et al. Diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2018;68(2):723–750.CrossRefGoogle Scholar
  4. 4.
    Marrero JA, Fontana RJ, Barrat A, et al. Prognosis of hepatocellular carcinoma: comparison of 7 staging systems in an American cohort. Hepatology. 2005;41(4):707–716.CrossRefGoogle Scholar
  5. 5.
    O’Neil BH, Venook AP. Hepatocellular carcinoma: the role of the North American GI Steering Committee Hepatobiliary Task Force and the advent of effective drug therapy. Oncologist. 2007;12(12):1425–1432.CrossRefGoogle Scholar
  6. 6.
    Cillo U, Vitale A, Grigoletto F, et al. Prospective validation of the Barcelona Clinic Liver Cancer staging system. J Hepatol. 2006;44(4):723–731.CrossRefGoogle Scholar
  7. 7.
    European Association for the Study of the Liver, European Organisation for Research and Treatment of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56(4):908–943.CrossRefGoogle Scholar
  8. 8.
    Esnaola NF, Lauwers GY, Mirza NQ, et al. Predictors of microvascular invasion in patients with hepatocellular carcinoma who are candidates for orthotopic liver transplantation. J Gastrointest Surg. 2002;6(2):224–232 (discussion 232).CrossRefGoogle Scholar
  9. 9.
    Pawlik TM, Delman KA, Vauthey JN, et al. Tumor size predicts vascular invasion and histologic grade: implications for selection of surgical treatment for hepatocellular carcinoma. Liver Transpl. 2005;11(9):1086–1092.CrossRefGoogle Scholar
  10. 10.
    Guo H, Wu T, Lu Q, et al. Surgical resection improves long-term survival of patients with hepatocellular carcinoma across different Barcelona Clinic Liver Cancer stages. Cancer Manag Res. 2018;10:361–369.CrossRefGoogle Scholar
  11. 11.
    Cho Y, Sinn DH, Yu SJ, et al. Survival analysis of single large (> 5 cm) hepatocellular carcinoma patients: BCLC A versus B. PLoS One. 2016;11(11):e0165722.CrossRefGoogle Scholar
  12. 12.
    Wada H, Eguchi H, Noda T, et al. Selection criteria for hepatic resection in intermediate-stage (BCLC stage B) multiple hepatocellular carcinoma. Surgery. 2016;160(5):1227–1235.CrossRefGoogle Scholar
  13. 13.
    Jung YK, Jung CH, Seo YS, et al. BCLC stage B is a better designation for single large hepatocellular carcinoma than BCLC stage A. J Gastroenterol Hepatol. 2016;31(2):467–474.CrossRefGoogle Scholar
  14. 14.
    Ng KK, Vauthey JN, Pawlik TM, et al. Is hepatic resection for large or multinodular hepatocellular carcinoma justified? Results from a multi-institutional database. Ann Surg Oncol. 2005;12(5):364–373.CrossRefGoogle Scholar
  15. 15.
    Pawlik TM, Poon RT, Abdalla EK, et al. Critical appraisal of the clinical and pathologic predictors of survival after resection of large hepatocellular carcinoma. Arch Surg. 2005;140(5):450–457 (discussion 457458).CrossRefGoogle Scholar
  16. 16.
    Pandey D, Lee KH, Wai CT, Wagholikar G, Tan KC. Long term outcome and prognostic factors for large hepatocellular carcinoma (10 cm or more) after surgical resection. Ann Surg Oncol. 2007;14(10):2817–2823.CrossRefGoogle Scholar
  17. 17.
    Liu PH, Su CW, Hsu CY, et al. Solitary large hepatocellular carcinoma: staging and treatment strategy. PLoS One. 2016;11(5):e0155588.CrossRefGoogle Scholar
  18. 18.
    Kim H, Ahn SW, Hong SK, et al. Survival benefit of liver resection for Barcelona Clinic Liver Cancer stage B hepatocellular carcinoma. Br J Surg. 2017;104(8):1045–1052.CrossRefGoogle Scholar
  19. 19.
    Liang L, Xing H, Zhang H, et al. Surgical resection versus transarterial chemoembolization for BCLC intermediate stage hepatocellular carcinoma: a systematic review and meta-analysis. HPB (Oxford). 2018;20(2):110–119.CrossRefGoogle Scholar
  20. 20.
    Hyun MH, Lee YS, Kim JH, et al. Hepatic resection compared to chemoembolization in intermediate- to advanced-stage hepatocellular carcinoma: a meta-analysis of high-quality studies. Hepatology. 2018;68(3):977–993.CrossRefGoogle Scholar
  21. 21.
    Moris D, Tsilimigras DI, Kostakis ID, et al. Anatomic versus non-anatomic resection for hepatocellular carcinoma: a systematic review and meta-analysis. Eur J Surg Oncol. 2018;44(7):927-938.CrossRefGoogle Scholar
  22. 22.
    Moris D, Rahnemai-Azar AA, Tsilimigras DI, et al. Updates and critical insights on glissonian approach in liver surgery. J Gastrointest Surg. 2018;22(1):154–163.CrossRefGoogle Scholar
  23. 23.
    Labgaa I, Demartines N, Melloul E. Surgical resection versus transarterial chemoembolization for intermediate stage hepatocellular carcinoma (BCLC-B): an unsolved question. Hepatology. 2019;69(2):923.CrossRefGoogle Scholar
  24. 24.
    Mo DC, Jia RR, Zhong JH. hepatic resection compared to chemoembolization in intermediate to advanced-stage HCC: a comment for moving forward. Hepatology. Epub 5 Dec 2018.Google Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Diamantis I. Tsilimigras
    • 1
  • Fabio Bagante
    • 1
    • 2
  • Kota Sahara
    • 1
  • Dimitrios Moris
    • 1
  • J. Madison Hyer
    • 1
  • Lu Wu
    • 1
  • Francesca Ratti
    • 3
  • Hugo P. Marques
    • 4
  • Olivier Soubrane
    • 5
  • Anghela Z. Paredes
    • 1
  • Vincent Lam
    • 6
  • George A. Poultsides
    • 7
  • Irinel Popescu
    • 8
  • Sorin Alexandrescu
    • 8
  • Guillaume Martel
    • 9
  • Aklile Workneh
    • 9
  • Alfredo Guglielmi
    • 2
  • Tom Hugh
    • 10
  • Luca Aldrighetti
    • 3
  • Itaru Endo
    • 11
  • Timothy M. Pawlik
    • 1
    Email author
  1. 1.Department of SurgeryThe Ohio State University Wexner Medical CenterColumbusUSA
  2. 2.Department of SurgeryUniversity of VeronaVeronaItaly
  3. 3.Department of SurgeryOspedale San RaffaeleMilanItaly
  4. 4.Department of SurgeryCurry Cabral HospitalLisbonPortugal
  5. 5.Department of Hepatobiliopancreatic SurgeryAPHP, Beaujon HospitalClichyFrance
  6. 6.Department of SurgeryWestmead HospitalSydneyAustralia
  7. 7.Department of SurgeryStanford UniversityStanfordUSA
  8. 8.Department of SurgeryFundeni Clinical InstituteBucharestRomania
  9. 9.Department of SurgeryUniversity of OttawaOttawaCanada
  10. 10.Department of SurgeryThe University of Sydney, School of MedicineSydneyAustralia
  11. 11.Yokohama City University School of MedicineYokohamaJapan

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