Research Surgical outcomes of hepatocellular carcinoma patients with Child-Pugh grade B liver function and beyond Milan criteria

Abstract

Abstract Background Due to impaired liver function, hepatocellular carcinoma (HCC) patients with Child-Pugh grade B (CPG-B) liver function need carefully chosen treatment. Radical treatment for patients beyond Milan criteria is limited. It has not been established whether hepatectomy is safe and effective under these circumstances. Methods This was a retrospective analysis of patients from January 2010 to October 2021 in a tertiary care centre. Postoperative complications and oncological prognosis were observed. Then, we investigated the feasibility of major hepatectomy for HCC in patients with CPG-B liver function. Results Among HCC patients with CPG-B liver function, recurrence-free survival (RFS) and overall survival (OS) significantly differed between patients with Milan criteria and those beyond Milan criteria (p < 0.05), but there was no significant difference in 90-day mortality (4.8% vs. 4.4%) or postoperative complications (55.4% vs. 57.0%). The 1-, 3-, and 5-year RFS for patients beyond Milan criteria were 42.2%, 22.8%, and 15.1%, respectively, while the 1-, 3-, and 5-year OS were 76.6%, 48.1%, and 36.0%, respectively. In HCC patients beyond Milan criteria, an inverse probability treatment weighting (IPTW) analysis revealed significant differences in RFS and OS between minor hepatectomy and major hepatectomy (p < 0.05). Cox proportional analysis also revealed that major hepatectomy was a prognostic factor for worse RFS (hazard ratio (HR): 1.77, 95% confidence interval (CI): 1.14–2.73) and OS (HR: 1.57, 95% CI: 1.01–2.82). Conclusion Hepatectomy is still feasible in HCC patients with CPG-B liver function and beyond Milan criteria, but major hepatectomy will result in a poor prognosis.