A Conceptual Classification of Resectability for Hepatocellular Carcinoma

• Published in: World journal of surgery Vol. 47; no. 3; pp. 740 - 748
• Main Authors: Yoh, Tomoaki, Ishii, Takamichi, Nishio, Takahiro, Koyama, Yukinori, Ogiso, Satoshi, Fukumitsu, Ken, Uchida, Yoichiro, Ito, Takashi, Seo, Satoru, Hata, Koichiro, Hatano, Etsuro
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.03.2023; Springer Nature B.V
• Subjects: Abdominal Surgery; Carcinoma, Hepatocellular - pathology; Cardiac Surgery; Classification; General Surgery; Hepatectomy; Hepatocellular carcinoma; Humans; Liver; Liver cancer; Liver diseases; Liver Neoplasms - pathology; Medical prognosis; Medicine; Medicine & Public Health; Multivariate analysis; Neoplasm Invasiveness; Original Scientific Report; Prognosis; Retrospective Studies; Strategy; Surgery; Survival; Thoracic Surgery; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-022-06803-7

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.