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J Hepatol. 2015 Mar;62(3):617-24. doi: 10.1016/j.jhep.2014.10.037. Epub 2014 Oct 30.

Survival benefit of liver resection for patients with hepatocellular carcinoma across different Barcelona Clinic Liver Cancer stages: a multicentre study.

Author information

1
Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
2
Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy. Electronic address: burra@unipd.it.
3
Biostatistics Unit, University of Padua, Padua, Italy.
4
Department of Medical and Surgical Sciences, Division of Semeiotics, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
5
Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, USA.
6
Department of Internal Medicine, Division of Gastroenterology, University of Genova, Genova, Italy.
7
Division of Surgery, San Marco Hospital, Zingonia, Italy.
8
Department of Gastroenterology and Internal Medicine, Division of Internal Medicine, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
9
Division of Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Università Cattolica del Sacro Cuore, Rome, Italy.
10
Division of Medicine, Bolognini Hospital, Seriate, Italy.
11
Division of Gastroenterology, Belcolle Hospital, Viterbo, Italy.
12
Department of Medicine, Division of Radiology, Fatebenefratelli Hospital, Milan, Italy.
13
Biomedical Department of Internal and Specialistic Medicine, Division of Gastroenterology, University of Palermo, Palermo, Italy.
14
Bolzano Regional Hospital, Division of Gastroenterology, Bolzano, Italy.
15
Division of Internal Medicine and Gastroenterology, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy.
16
Division of Gastroenterology and Metabolic Diseases, University Hospital of Pisa, Pisa, Italy.
17
Department of Internal Medicine, Ospedale per gli Infermi di Faenza, Faenza, Italy.
18
Division of Infectious Diseases and Hepatology, University Hospital of Parma, Parma, Italy.
19
Department of Medicine and Surgery, Division of Gastroenterology, University of Naples, "Federico II", Naples, Italy.
20
Division of Gastroenterology, Polytechnic University of Marche, Ancona, Italy.
21
Biomedical Department of Internal and Specialistic Medicine, Division of Internal Medicine 2, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy.

Abstract

BACKGROUND & AIMS:

The role of hepatic resection for hepatocellular carcinoma (HCC) in different Barcelona Clinic Liver Cancer (BCLC) stages is controversial. We aimed at measuring the survival benefit of resection vs. non-surgical-therapies in each BCLC stage.

METHODS:

Using the ITA.LI.CA database, we identified 2090 BCLC A, B, and C HCC patients observed between 2000 and 2012: 550 underwent resection, 1046 loco-regional therapy (LRT), and 494 best supportive care (BSC). A multivariate log-logistic model was chosen to predict median survival (MS) after resection vs. MS after LRT or BSC. The results were expressed as net survival benefit of resection: (MS resection-MS LRT)/MS BSC.

RESULTS:

After stratifying for BCLC stage, the median net survival benefit of resection over LRT was: BCLC 0=62% (40%, 82%), A=45% (13%, 65%), B=46% (9%, 76%), C=-16% (-55%, 33%). Model for end-stage liver disease (MELD) score>9, Child B class, and performance status (PST)=2 were the main risk factors for liver resection. 1181 Child A patients (57%) with MELD⩽9 and PST<2 had always a large positive net survival benefit of resection over LRT, independently of BCLC stage: BCLC 0=64% (44%, 85%), A=59% (45%, 74%), B=71% (52%, 90%), C=56% (36%, 78%). Among the 909 (43%) patients with at least one risk factor (MELD>9 or PST=2 or Child B class), resection did not prove any survival benefit over LRT.

CONCLUSIONS:

Resection could result in survival benefit over LRT for HCC patients regardless of their BCLC stage, provided that liver dysfunction (Child B or MELD>9) and PST>1 are absent.

KEYWORDS:

Best supportive care; Cirrhosis; Hepatocellular carcinoma; Liver resection; Loco-regional therapies; Survival benefit

PMID:
25450706
DOI:
10.1016/j.jhep.2014.10.037
[Indexed for MEDLINE]

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