Tumor number and Model for End-Stage Liver Disease score as selection criteria for liver resection in intermediate-stage hepatocellular carcinoma

Author:

Yen Yi-Hao1,Li Wei-Feng2,Liu Yueh-Wei2,Yong Chee-Chien2,Wang Chih-Chi2,Lin Chih-Yun2

Affiliation:

1. Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine

2. Kaohsiung Chang Gung Memorial Hospital

Abstract

Abstract Purpose Many studies have reported preoperative predictors of overall survival (OS) of patients undergoing liver resection (LR) for Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC); however, the results are inconsistent. We aim to clarify this issue. Methods We enrolled 719 patients with BCLC stage A and single HCC 2.0–5.0 cm (designated A1), 294 patients with BCLC stage A and single HCC > 5.0 cm (designated A2), and 170 patients with BCLC stage B undergoing LR during 2011–2021. Results Multivariate analysis showed that alpha-fetoprotein (AFP) > 400 ng/ml (hazard ratio [HR] = 1.980; 95% confidence interval [CI] = 1.151–3.405; p = 0.014), tumor number > 3 (HR = 2.036; 95% CI = 1.200–3.457; p = 0.008), and Model for End-Stage Liver Disease (MELD) score > 9 (HR = 2.102; 95% CI = 1.244–3.551; p = 0.006) were associated with BCLC stage B patients’ 5-year OS. Using β estimates from multivariate analysis, we constructed a linear predictor of BCLC stage B patients’ OS. Based on the Kaplan–Meier estimator, we divided BCLC stage B patients into two groups: BCLC B1 group with ≤ 3 tumors and MELD score ≤ 9, irrespective of AFP level; and BCLC B2 group with > 3 tumors or MELD score > 9, irrespective of AFP level. The 5-year OS of BCLC A1, A2, B1, and B2 was 78%, 66%, 60%, and 23%, respectively (p < 0.001). OS was significantly different between A1 and A2 (p = 0.012) and B1 and B2 (p < 0.001), but not between A2 and B1 (p = 0.576). Conclusion Patients with BCLC B1 HCC may be ideal candidates for LR because their OS is comparable to that of BCLC A2 patients.

Publisher

Research Square Platform LLC

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