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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 11/2019

01-10-2019 | Liver Resection | Hepatobiliary Tumors

Prognosis After Resection of Barcelona Clinic Liver Cancer (BCLC) Stage 0, A, and B Hepatocellular Carcinoma: A Comprehensive Assessment of the Current BCLC Classification

Authors: Diamantis I. Tsilimigras, MD, Fabio Bagante, MD, Kota Sahara, MD, Dimitrios Moris, MD, PhD, J. Madison Hyer, MS, Lu Wu, MD, Francesca Ratti, MD, Hugo P. Marques, MD, Olivier Soubrane, MD, Anghela Z. Paredes, MD, MS, Vincent Lam, MD, George A. Poultsides, MD, Irinel Popescu, MD, Sorin Alexandrescu, MD, Guillaume Martel, MD, Aklile Workneh, MD, Alfredo Guglielmi, MD, Tom Hugh, MD, Luca Aldrighetti, MD, Itaru Endo, MD, PhD, Timothy M. Pawlik, MD, MPH, PhD, FACS

Published in: Annals of Surgical Oncology | Issue 11/2019

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Abstract

Background

Although the Barcelona Clinic Liver Cancer (BCLC) staging system has been largely adopted in clinical practice, recent studies have questioned the prognostic stratification of this classification schema, as well as the proposed treatment allocation of patients with a single large tumor.

Methods

Patients who underwent curative-intent hepatectomy for histologically proven hepatocellular carcinoma (HCC) between 1998 and 2017 were identified using an international multi-institutional database. Overall survival (OS) among patients with BCLC stage 0, A, and B was examined. Patients with a single large tumor were classified as BCLC stage A1 and were independently assessed.

Results

Among 814 patients, 68 (8.4%) were BCLC-0, 310 (38.1%) were BCLC-A, 279 (34.3%) were BCLC-A1, and 157 (19.3%) were BCLC-B. Five-year OS among patients with BCLC stage 0, A, A1, and B HCC was 86.2%, 69.0%, 56.9%, and 49.9%, respectively (p < 0.001). Among patients with very early- and early-stage HCC (BCLC 0, A, and A1), patients with BCLC stage A1 had the worst OS (p = 0.0016). No difference in survival was noted among patients undergoing surgery for BCLC stage A1 and B HCC (5-year OS: 56.9% vs. 49.9%; p = 0.259) even after adjusting for competing factors (hazard ratio 0.83, 95% confidence interval 0.54–1.28; p = 0.40).

Conclusion

Prognosis following liver resection among patients with BCLC-A1 HCC was similar to patients presenting with BCLC-B tumors. Surgery provided acceptable long-term outcomes among select patients with BCLC-B HCC. Designation into BCLC stage B should not be considered an a priori contraindication to surgery.
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Metadata
Title
Prognosis After Resection of Barcelona Clinic Liver Cancer (BCLC) Stage 0, A, and B Hepatocellular Carcinoma: A Comprehensive Assessment of the Current BCLC Classification
Authors
Diamantis I. Tsilimigras, MD
Fabio Bagante, MD
Kota Sahara, MD
Dimitrios Moris, MD, PhD
J. Madison Hyer, MS
Lu Wu, MD
Francesca Ratti, MD
Hugo P. Marques, MD
Olivier Soubrane, MD
Anghela Z. Paredes, MD, MS
Vincent Lam, MD
George A. Poultsides, MD
Irinel Popescu, MD
Sorin Alexandrescu, MD
Guillaume Martel, MD
Aklile Workneh, MD
Alfredo Guglielmi, MD
Tom Hugh, MD
Luca Aldrighetti, MD
Itaru Endo, MD, PhD
Timothy M. Pawlik, MD, MPH, PhD, FACS
Publication date
01-10-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 11/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07580-9

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