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

Alessandro Vitale, Patrizia Burra, Anna Chiara Frigo, Franco Trevisani, Fabio Farinati, Gaya Spolverato, Michael Volk, Edoardo G. Giannini, Francesca Ciccarese, Fabio Piscaglia, Gian Lodovico Rapaccini, Mariella Di Marco, Eugenio Caturelli, Marco Zoli, Franco Borzio, Giuseppe Cabibbo, Martina Felder, Antonio Gasbarrini, Rodolfo Sacco, Francesco Giuseppe FoschiGabriele Missale, Filomena Morisco, Gianluca Svegliati Baroni, Roberto Virdone, Umberto Cillo

Research output: Contribution to journalArticle

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 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.

Original languageEnglish
Pages (from-to)617-624
Number of pages8
JournalJournal of Hepatology
Volume62
Issue number3
DOIs
Publication statusPublished - Mar 1 2015

Keywords

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

ASJC Scopus subject areas

  • Hepatology
  • Medicine(all)

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