Abstract
BackgroundThe benefits of surgical resection (SR) for various Barcelona Clinic Liver Cancer (BCLC) stages of hepatocellular carcinoma (HCC) remain unclear. We investigated the risk factors of overall survival (OS) and survival benefits of SR over nonsurgical treatments in patients with HCC of various BCLC stages.MethodsOverall, 2316 HCC patients were included, and their clinicopathological data and OS were recorded. OS was analyzed by the Kaplan-Meier method and Cox regression analysis. Propensity score matching (PSM) analysis was performed.Results In total, 66 (2.8%), 865 (37.4%), 575 (24.8%) and 870 (35.0%) patients had BCLC stage 0, A, B, and C disease, respectively. Furthermore, 1302 (56.2%) of all patients, and 37 (56.9%), 472 (54.6%), 313 (54.4%) and 480 (59.3%) of patients with BCLC stage 0, A, B, and C disease, respectively, died. The median follow-up duration time was 20 (range 0–96) months for the total cohort and was subdivided into 52 (8–96), 32 (1–96), 19 (0–84), and 12 (0–79) months for BCLC stages 0, A, B, and C cohorts, respectively. The risk factors for OS were (1) SR and cirrhosis; (2) SR, cirrhosis, and Child–Pugh (C–P) class; (3) SR, hepatitis B virus (HBV) infection, and C–P class; and (4) SR, HBV infection, and C–P class for the BCLC stage 0, A, B, and C cohorts, respectively. Compared to non-SR treatment, SR resulted in significantly higher survival rates in all cohorts. The 5-year OS rates for SR vs. non-SR were 44.0% versus 28.7%, 72.2% versus 42.6%, 42.6% versus 36.2, 44.6% versus 23.5%, and 41.4% versus 15.3% (all P values < 0.05) in the total and BCLC stage 0, A, B, and C cohorts, respectively. After PSM, SR resulted in significantly higher survival rates compared to non-SR treatment in various BCLC stages.ConclusionsSR conferred significant survival benefits to patients with HCC of various BCLC stages and should be considered a recommended treatment for select HCC patients, especially patients with BCLC stage B and C disease.
Highlights
The benefits of surgical resection (SR) for various Barcelona Clinic Liver Cancer (BCLC) stages of hepato‐ cellular carcinoma (HCC) remain unclear
The study was conducted in accordance with the guidelines of the 2759 patients diagnosed with HCC 291 BCLC staged unknown 247 BCLC stage D 5 related to liver transplant
Our results demonstrated that the risk factors for overall survival (OS) were SR, cirrhosis, C–P class, and hepatitis B virus (HBV) infection within groups with different BCLC stages (Table 2)
Summary
The benefits of surgical resection (SR) for various Barcelona Clinic Liver Cancer (BCLC) stages of hepato‐ cellular carcinoma (HCC) remain unclear. We investigated the risk factors of overall survival (OS) and survival benefits of SR over nonsurgical treatments in patients with HCC of various BCLC stages. The Barcelona Clinic Liver Cancer (BCLC) system is widely utilized because it incorporates tumor burden, liver cirrhosis severity, and patient performance status and is advantageous for treatment and prognostic assessment [4, 6, 7]. Several prognostic factors, including age, treatment, liver function, tumor size, and etiology, are associated with OS in HCC patients [15, 16]. This study aimed to investigate the risk factors of OS and the potential benefits of SR over nonsurgical treatments in a large cohort of HCC patients
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