Hepatic Resection Provides Survival Benefit for Selected Intermediate-Stage (BCLC-B) Hepatocellular Carcinoma Patients
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Purpose The intermediate stage of hepatocellular carcinoma (HCC) (Barcelona Clinic Liver Cancer [BCLC] B) comprises a highly heterogeneous population, and the treatment strategy is still controversial. Because of the heterogeneity, a subclassification of intermediate-stage HCCs was put forward by Bolondi according to the ‘beyond Milan and within up-to-7’ criteria and Child-Pugh score. In this study, we aim to analyze the prognosis of BCLC-B stage HCC patients who received hepatic resection according to the Bolondi’s subclassification. Materials and Methods One thousand and one hundred three patients diagnosed with HCC and treated with hepatic resection were enrolled in our hospital between 2006 and 2012. According to Bolondi’s subclassification, the BCLC-B patients were divided into four groups. Recurrence-free survival (RFS) and overall survival (OS) were analyzed. Results According to Bolondi’s subclassification, the BCLC-B patients were divided into four groups: B1 (n=41, 18.7%), B2 (n=160, 73.1%), B3 (n=11, 5.0%), and B4 (n=7, 3.2%). Significant difference was observed between B1 and other groups (B1 vs. B2, p=0.022; B1 vs. B3, p < 0.001; B1 vs. B4, p < 0.001), but no difference for B2 vs. B4 (p=0.542) and B3 vs. B4 (p=0.542). In addition, no significant differences were observed between BCLC-A and BCLCB1 group for both RFS (p=0.087) and OS (p=0.643). In multivariate analysis, BCLC-B subclassification was not a risk factor for both OS (p=0.263) and RFS (p=0.892). Conclusion In our study, HCC patients at B1 stage were benefited from hepatic resection and had similar survival to BCLC-A stage patients. Our study provided rationality of hepatic resection for selected BCLC-B stage HCC patients instead of routine transarterial chemoembolization.
Abstract
Purpose The intermediate stage of hepatocellular carcinoma (HCC) (Barcelona Clinic Liver Cancer [BCLC] B) comprises a highly heterogeneous population, and the treatment strategy is still controversial. Because of the heterogeneity, a subclassification of intermediate-stage HCCs was put forward by Bolondi according to the ‘beyond Milan and within up-to-7’ criteria and Child-Pugh score. In this study, we aim to analyze the prognosis of BCLC-B stage HCC patients who received hepatic resection according to the Bolondi’s subclassification. Materials and Methods One thousand and one hundred three patients diagnosed with HCC and treated with hepatic resection were enrolled in our hospital between 2006 and 2012. According to Bolondi’s subclassification, the BCLC-B patients were divided into four groups. Recurrence-free survival (RFS) and overall survival (OS) were analyzed. Results According to Bolondi’s subclassification, the BCLC-B patients were divided into four groups: B1 (n=41, 18.7%), B2 (n=160, 73.1%), B3 (n=11, 5.0%), and B4 (n=7, 3.2%). Significant difference was observed between B1 and other groups (B1 vs. B2, p=0.022; B1 vs. B3, p < 0.001; B1 vs. B4, p < 0.001), but no difference for B2 vs. B4 (p=0.542) and B3 vs. B4 (p=0.542). In addition, no significant differences were observed between BCLC-A and BCLCB1 group for both RFS (p=0.087) and OS (p=0.643). In multivariate analysis, BCLC-B subclassification was not a risk factor for both OS (p=0.263) and RFS (p=0.892). Conclusion In our study, HCC patients at B1 stage were benefited from hepatic resection and had similar survival to BCLC-A stage patients. Our study provided rationality of hepatic resection for selected BCLC-B stage HCC patients instead of routine transarterial chemoembolization.
참고문헌 (25)
- Ferlay J, "Estimates of worldwide burden of cancer in 2008 : GLOBOCAN 2008", Int J Cancer, 127, pp.2893~2917 (2010)
- Pang Q, "The prognostic value of platelet count in patients with hepatocellular carcinoma: a systematic review and meta-analysis", Medicine (Baltimore), 94, pp.e1431~ (2015)
- Forner A, "Hepatocellular carcinoma", Lancet, 379, pp.1245~1255 (2012)
- Llovet JM, "Design and endpoints of clinical trials in hepatocellular carcinoma", J Natl Cancer Inst, 100, pp.698~711 (2008)
- Chang WT, "Hepatic resection can provide long-term survival of patients with non-early-stage hepatocellular carcinoma: extending the indication for resection?", Surgery, 152, pp.809~820 (2012)
- Zhong JH, "Hepatic resection associated with good survival for selected patients with intermediate and advanced-stage hepatocellular carcinoma", Ann Surg, 260, pp.329~340 (2014)
- Choi SH, "Role of surgical resection for multiple hepatocellular carcinomas", World J Gastroenterol, 19, pp.366~374 (2013)
- Farinati F, "BCLC stage B hepatocellular carcinoma and transcatheter arterial chemoembolization : a 20-year survey by the Italian Liver Cancer group", Liver Int, 35, pp.223~231 (2015)
- Vitale A, "Survival benefit of liver resection for patients with hepatocellular carcinoma across different Barcelona Clinic Liver Cancer stages : a multicentre study", J Hepatol, 62, pp.617~624 (2015)
- Bolondi L, "Heterogeneity of patients with intermediate(BCLC-B)hepatocellular carcinoma : proposal for a subclassification to facilitate treatment decisions", Semin Liver Dis, 32, pp.348~359 (2012)
- Weinmann A, "Survival analysis of proposed BCLC-B subgroups in hepatocellular carcinoma patients", Liver Int, 35, pp.591~600 (2015)
- Giannini EG, "Application of the intermediate-stage subclassification to patients with untreated hepatocellular carcinoma", Am J Gastroenterol, 111, pp.70~77 (2016)
- Kudo M, "Subclassification of BCLC B stage hepatocellular carcinoma and treatment strategies : proposal of modified Bolondi's subclassification(Kinki Criteria)", Dig Dis, 33, pp.751~758 (2015)
- Maithel SK, "Importance of low preoperative platelet count in selecting patients for resection of hepatocellular carcinoma : a multi-institutional analysis", J Am Coll Surg, 212, pp.638~648 (2011)
- Lim C, "Hepatectomy for hepatocellular carcinoma larger than 10 cm : preoperative risk stratification to prevent futile surgery", HPB(Oxford), 17, pp.611~623 (2015)
- Bruix J, "American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update", Hepatology, 53, pp.1020~1022 (2011)
- Sutherland F, "Claude Couinaud : a passion for the liver", Arch Surg, 137, pp.1305~1310 (2002)
- Dhir M, "A review and update of treatment options and controversies in the management of hepatocellular carcinoma", Ann Surg, 263, pp.1112~1125 (2016)
- "EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma", J Hepatol, 56, pp.908~943 (2012)
- Ciria R, "Optimizing the management of patients with BCLC stage-B hepatocellular carcinoma : modern surgical resection as a feasible alternative to transarterial chemoemolization", Eur J Surg Oncol, 41, pp.1153~1161 (2015)
- Arizumi T, "Validation of a modified substaging system (Kinki Criteria) for patients with intermediate-stage hepatocellular carcinoma", Oncology, 89(Suppl 2), pp.47~52 (2015)
- Adhoute X, "Hepatocellular carcinoma scoring and staging systems. Do we need new tools?", J Hepatol, 64, pp.1449~1450 (2016)
- Dufour JF, "Intermediate hepatocellular carcinoma: current treatments and future perspectives", Ann Oncol, 24(Suppl 2), pp.ii24~ii29 (2013)
- Yin L, "Partial hepatectomy vs. transcatheter arterial chemoembolization for resectable multiple hepatocellular carcinoma beyond Milan Criteria: a RCT", J Hepatol, 61, pp.82~88 (2014)
- Qi X, "Hepatic resection versus transarterial chemoembolization for the initial treatment of hepatocellular carcinoma : a systematic review and metaanalysis", Oncotarget, 6, pp.18715~18733 (2015)