Preoperative predictors of survival of patients with hepatocellular carcinoma undergoing liver resection beyond the updated Barcelona Clinic Liver Cancer criteria

Abstract

Abstract Purpose The updated 2022 Barcelona Clinic Liver Cancer (BCLC) guidelines recommend liver resection (LR) for single hepatocellular carcinoma (HCC) of any size, i.e., American Joint Committee on Cancer (AJCC) 7th edition image-defined stage 1. This study aimed to develop a model to preoperatively predict the survival of patients with HCC undergoing LR beyond the updated BCLC resection criteria. Methods Three hundred and three patients undergoing LR for HCC beyond the updated BCLC resection criteria between 2011 and 2017 were identified from the cancer registry database of our institution. A model to predict overall survival (OS) was developed and patients were classified using risk scores. Results Multivariate analysis of five-year OS identified three variables—AJCC 7th edition image-defined stage (stage 3 vs. 2; HR = 1.618; 95% CI = 1.061–2.467; p = 0.025), alpha-fetoprotein level (≥ 400 vs. < 400 ng/ml; HR = 1.837; 95% CI = 1.252–2.697, p = 0.002), and cirrhosis (presence vs. absence; HR = 1.569; 95% CI = 1.092–2.254; p = 0.015)—as independent prognostic factors of survival, which were used to formulate risk scores. Patients were divided into low-, medium-, and high-risk groups; their five-year OS was 86%, 56%, and 36% (p < 0.001) and five-year recurrence-free survival was 44%, 32%, and 19% (p = 0.001), respectively. Conclusion We developed a simple model that can preoperatively predict the survival of patients with HCC who are candidates for LR beyond the updated BCLC resection criteria.