A Conceptual Classification of Resectability for Hepatocellular Carcinoma
Backgrounds In the era of multidisciplinary treatment strategy, resectability for hepatocellular carcinoma (HCC) should be defined. This study aimed to propose and validate a resectability classification of HCC. Methods We proposed following the three groups; resectable-(R), borderline resectable-(B...
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Published in | World journal of surgery Vol. 47; no. 3; pp. 740 - 748 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Cham
Springer International Publishing
01.03.2023
Springer Nature B.V |
Subjects | |
Online Access | Get full text |
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Summary: | Backgrounds
In the era of multidisciplinary treatment strategy, resectability for hepatocellular carcinoma (HCC) should be defined. This study aimed to propose and validate a resectability classification of HCC.
Methods
We proposed following the three groups; resectable-(R), borderline resectable-(BR), and unresectable (UR)-HCCs. Resectable two groups were sub-divided according to the value of indocyanine green clearance of remnant liver (ICG-Krem) and presence of macrovascular invasion (MVI); BR-HCC was defined as resectable HCCs with MVI and/or ICG-Krem≥0.03–<0.05, and R-HCC was the remaining. Consecutive patients with HCC who underwent liver resection (LR) and non-surgical treatment(s) (i.e., UR-HCC) between 2011 and 2017 were retrospectively analyzed to validate the proposed classification.
Results
A total of 361 patients were enrolled in the study. Of these, R-, BR- and UR-HCC were found in 251, 46, and 64 patients, respectively. In patients with resected HCC, ICG-Krem≥0.05 was associated with decreased risk of clinically relevant posthepatectomy liver failure (
p
=0.013) and the presence of MVI was associated with worse overall survival (OS) (
p
<0.001). The 3–5-years OS rates according to the proposed classification were 80.3, and 68.3% versus 51.4, and 35.6%, in the R and BR groups, respectively (both
p
<0.001). Multivariate analysis showed BR-HCC was independently associated with poorer OS (
p
<0.001) after adjusting for known tumor prognostic factors. Meanwhile, BR-HCC was associated with benefit in terms of OS compared with UR-HCC (
p
<0.001).
Conclusion
Our proposal of resectability for HCC allows for stratifying survival outcomes of HCC and may help to determine treatment strategy. |
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Bibliography: | The online version contains supplementary material available at Copyright comment The original online version of this article was revised due to a retrospective Open Access order. Supplementary Information corrected publication 2022 https://doi.org/10.1007/s00268‐022‐06803‐7 A correction to this article is available online at https://doi.org/10.1007/s00268‐022‐06838‐w . ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0364-2313 1432-2323 |
DOI: | 10.1007/s00268-022-06803-7 |