Long-term results of surgical treatment in patients with intermediate stage (BCLC B) hepatocellular carcinoma: a single-center retrospective study

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Abstract

Introduction. The appropriateness of liver resection in patients with intermediate stage hepatocellular carcinoma (HCC) according to Barcelona Clinic Liver Cancer (BCLC stage B, BCLC B) is a subject of debate.

Aim. Aim of the study is an analysis of long-term treatment results in patients with HCC BCLC B who underwent liver resection.

Materials and methods. The retrospective analysis included patients with HCC BCLC B who underwent liver resection at the N. N. Blokhin National Medical Research Center of Oncology in the period from 2000 to 2022. The incidence of postoperative complications and mortality, overall survival (OS) and progression-free survival (PFS), as well as factors influencing these indicators, were assessed.

Results. Clinical data from 110 patients were analyzed. The overall incidence of postoperative complications was 29.1 % (n = 32), the incidence of clinically significant complications was 9 % (n = 10), and postoperative mortality was 2.7 % (n = 3). The median follow-up was 36 months. Three-year OS was 57.1 %, median OS was 76.4 months. Three-year PFS was 31.3 %, median PFS was 13.3 months. In a multivariate analysis, a low degree of tumor differentiation was a factor that negatively affected OS (odds ratio 2.323, 95 % confidence interval 1.162–4.644, p = 0.017) and PFS (odds ratio 2.257, 95 % confidence interval 1.304–3.906, p = 0.004).

Conclusion. Liver resection may improve long-term treatment outcomes in a selected group of patients with HCC BCLC B.

About the authors

B. I. Sakibov

N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia

Author for correspondence.
Email: bairamali_10@mail.ru

Bairamali Izzatovich Sakibov, 

24 Kashirskoye Shosse, Moscow 115522

Russian Federation

D. V. Podluzhnyi

N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia

Email: fake@neicon.ru

24 Kashirskoye Shosse, Moscow 115522

Russian Federation

Yu. I. Patyutko

N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia

Email: fake@neicon.ru

24 Kashirskoye Shosse, Moscow 115522

Russian Federation

O. A. Egenov

N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia

Email: fake@neicon.ru

24 Kashirskoye Shosse, Moscow 115522

Russian Federation

N. E. Kudashkin

N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia;
N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia

Email: fake@neicon.ru

24 Kashirskoye Shosse, Moscow 115522;

1 Ostrovityanova St., Moscow 117997

Russian Federation

References

  1. Reig M., Forner A., Rimola J. et al. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J Hepatol 2022;76(3):681–93. doi: 10.1016/j.jhep.2021.11.018
  2. Breder V.V., Bazin I.S., Balakhnin P.V. et al. Malignant tumors of the liver and biliary system. Practical recommendations RUSSCO, part 1.1. Zlokachestvennye opukholi = Malignant tumors 2024;14(3s2):358–403. doi: 10.18027/2224-5057-2024-14-3s2-1.1-17
  3. Vogel A., Cervantes A., Chau I. et al. Hepatocellular carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018;29(Suppl 4):iv238–iv55. doi: 10.1093/annonc/mdy308
  4. Abdurahmanov D.T., Alieva S.B., Balakhnin P.V. et al. Clinical guidelines. Liver cancer (hepatocellular). Moscow: Association of Oncologists of Russia, 2022. 67 p.
  5. 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):110–9. doi: 10.1016/j.hpb.2017.10.004
  6. Stevens C.L., Awad A., Abbas S.M. et al. Systematic review and meta-analysis of hepatic resection versus transarterial chemoembolization for solitary large hepatocellular carcinoma. HPB (Oxford) 2017;19(8):653–8. doi: 10.1016/j.hpb.2017.03.009
  7. Labgaa I., Taffé P., Martin D. et al. Comparison of partial hepatectomy and transarterial chemoembolization in intermediatestage hepatocellular carcinoma: a systematic review and metaanalysis. Liver Cancer 2020;9(2):138–47. doi: 10.1159/000505093
  8. Hyun M.H., Lee Y.S., Kim J.H. 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):977–93. doi: 10.1002/hep.29883
  9. Dindo D. The Clavien–Dindo classification of surgical complications. In: Treatment of postoperative complications after digestive surgery. Springer, 2014. Pp. 13–17. doi: 10.1007/978-1-4471-4354-3_3
  10. Rahbari N.N., Garden O.J., Padbury R. et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 2011;149(5):713–24. doi: 10.1016/j.surg.2010.10.001
  11. Mehrabi A., Abbasi Dezfouli S., Schlösser F. et al. Validation of the ISGLS classification of bile leakage after pancreatic surgery: A rare but severe complication. Eur J Surg Oncol 2022;48(12):2440–7. doi: 10.1016/j.ejso.2022.06.030
  12. Rahbari N.N., Garden O.J., Padbury R. et al. Post-hepatectomy haemorrhage: a definition and grading by the International Study Group of Liver Surgery (ISGLS). HPB (Oxford) 2011;13(8):528–35.
  13. Emenena I., Emenena B., Kweki A.G. et al. Model for end stage liver disease (MELD) score: a tool for prognosis and prediction of mortality in patients with decompensated liver cirrhosis. Cureus 2023;15(5):e39267. doi: 10.7759/cureus.39267
  14. Johnson P.J., Berhane S., Kagebayashi C. et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidencebased approach-the ALBI grade. J Clin Oncol 2015;33(6):550–8. doi: 10.1200/JCO.2014.57.9151
  15. Mazzaferro V., Llovet J.M., Miceli R. et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol 2009;10(1):35–43. doi: 10.1016/S1470-2045(08)70284-5
  16. Andreatos N., Amini N., Gani F. et al. Albumin-bilirubin score: predicting short-term outcomes including bile leak and posthepatectomy liver failure following hepatic resection. J Gastrointest Surg 2017;21(2):238–48. doi: 10.1007/s11605-016-3246-4
  17. Zhang J., Chen G., Zhang P. et al. The threshold of alphafetoprotein (AFP) for the diagnosis of hepatocellular carcinoma: A systematic review and meta-analysis. PLoS One 2020;15(2):e0228857. doi: 10.1371/journal.pone.0228857
  18. Sarin S.K., Kumar A. Gastric varices: profile, classification, and management. Am J Gastroenterol 1989;84(10):1244–9. PMID: 2679046
  19. 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):1227–35. doi: 10.1016/j.surg.2016.05.023
  20. Lopez-Lopez V., Kalt F., Zhong J.H. et al. The role of resection in hepatocellular carcinoma BCLC stage B: A multi-institutional patient-level meta-analysis and systematic review. Langenbecks Arch of Surg 2024;409(1):277. doi: 10.1007/s00423-024-03466-x
  21. Berzigotti A., Reig M., Abraldes J.G. et al. Portal hypertension and the outcome of surgery for hepatocellular carcinoma in compensated cirrhosis: a systematic review and meta-analysis. Hepatology 2015;61(2):526–36. doi: 10.1002/hep.27431
  22. Benson A.B., D’Angelica M.I., Abbott D.E. et al. Hepatobiliary cancers, version 2.2021, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2021;19(5):541–65. doi: 10.6004/jnccn.2021.0022
  23. Azoulay D., Ramos E., Casellas-Robert M. et al. Liver resection for hepatocellular carcinoma in patients with clinically significant portal hypertension. JHEP Rep 2021;3(1):100190. doi: 10.1016/j.jhepr.2020.100190
  24. Cortese S., Tellado J.M. Impact and outcomes of liver resection for hepatocellular carcinoma in patients with clinically significant portal hypertension. Cir Cir;2022;90(5):579–87. doi: 10.24875/CIRU.22000041
  25. Kim J.Y., Sinn D.H., Gwak G.Y. et al. Transarterial chemoembolization versus resection for intermediate-stage (BCLC B) hepatocellular carcinoma. Clin Mol Hepatol 2016;22(2):250–8. doi: 10.3350/cmh.2016.0015
  26. Garancini M., Nespoli S., Romano F. et al. Surgical management of hepatocellular carcinoma within and beyond BCLC indications in a middle volume center. J Visc Surg 2018;155(4):275–82. doi: 10.1016/j.jviscsurg.2017.12.001
  27. Furukawa K., Shiba H., Horiuchi T. et al. Survival benefit of hepatic resection for hepatocellular carcinoma beyond the Barcelona Clinic Liver Cancer classification. J Hepatobiliary Pancreat Sci 2017;24(4):199–205. doi: 10.1002/jhbp.436
  28. Matsukuma S., Sakamoto K., Tokuhisa Y. et al. Outcomes following liver resection for multinodular Barcelona Clinic Liver Cancer-B hepatocellular carcinoma. Oncol Lett 2018;16(5):6383–92. doi: 10.3892/ol.2018.9420
  29. Wang X., Wang Z., Wu L. Combined measurements of tumor number and size helps estimate the outcome of resection of Barcelona clinic liver cancer stage B hepatocellular carcinoma. BMC Surg 2016;16:22. doi: 10.1186/s12893-016-0135-4
  30. Di Sandro S., Centonze L., Pinotti E. et al. Surgical and oncological outcomes of hepatic resection for BCLC-B hepatocellular carcinoma: a retrospective multicenter analysis among 474 consecutive cases. Updates Surg 2019;71(2):285–93. doi: 10.1007/s13304-019-00649-w
  31. Kariyama K., Nouso K., Wakuta A. et al. Treatment of intermediate-stage hepatocellular carcinoma in Japan: position of curative therapies. Liver Cancer 2020;9(1):41–9. doi: 10.1159/000502479
  32. Lin C.W., Chen Y.S., Lo G.H. et al. Comparison of overall survival on surgical resection versus transarterial chemoembolization with or without radiofrequency ablation in intermediate stage hepatocellular carcinoma: a propensity score matching analysis. BMC Gastroenterol 2020;20(1):99. doi: 10.1186/s12876-020-01235-w
  33. Fang Q., Xie Q.S., Chen J.M. et al. Long-term outcomes after hepatectomy of huge hepatocellular carcinoma: a single-center experience in China. Hepatobiliary Pancreat Dis Int 2019;18(6):532–7. doi: 10.1016/j.hbpd.2019.09.001
  34. Jianyong L., Lunan Y., Wentao W. et al. Barcelona clinic liver cancer stage B hepatocellular carcinoma: transarterial chemoembolization or hepatic resection? Medicine (Baltimore) 2014;93(26):e180. doi: 10.1097/MD.0000000000000180
  35. Kamiyama T., Orimo T., Wakayama K. et al. Survival outcomes of hepatectomy for stage B hepatocellular carcinoma in the BCLC classification. World J Surg Oncol 2017;15(1):156. doi: 10.1186/s12957-017-1229-x
  36. Tsilimigras D.I., Bagante F., Moris D. et al. Defining the chance of cure after resection for hepatocellular carcinoma within and beyond the Barcelona Clinic Liver Cancer guidelines: a multiinstitutional analysis of 1010 patients. Surgery 2019;166(6):967–74. doi: 10.1016/j.surg.2019.08.010

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