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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 7/2020

01-07-2020 | Hepatocellular Carcinoma | Hepatobiliary Tumors

Recurrence Patterns and Outcomes after Resection of Hepatocellular Carcinoma within and beyond the Barcelona Clinic Liver Cancer Criteria

Authors: Diamantis I. Tsilimigras, MD, Fabio Bagante, MD, Dimitrios Moris, MD, PhD, J. Madison Hyer, MS, Kota Sahara, MD, Anghela Z. Paredes, MD, MS, Rittal Mehta, MPH, Francesca Ratti, MD, Hugo P. Marques, MD, Olivier Soubrane, MD, 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 7/2020

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Abstract

Background

Several investigators have advocated for extending the Barcelona Clinic Liver Cancer (BCLC) resection criteria to select patients with BCLC-B and even BCLC-C hepatocellular carcinoma (HCC). The objective of the current study was to define the outcomes and recurrence patterns after resection within and beyond the current resection criteria.

Patients and Methods

Patients who underwent resection for HCC within (i.e., BCLC 0/A) and beyond (i.e. BCLC B/C) the current resection criteria between 2005 and 2017 were identified from an international multi-institutional database. Overall survival (OS), disease-free survival (DFS), as well as patterns of recurrence of patients undergoing HCC resection within and beyond the BCLC guidelines were examined.

Results

Among 756 patients, 602 (79.6%) patients were BCLC 0/A and 154 (20.4%) were BCLC B/C. Recurrences were mostly intrahepatic (within BCLC: 74.3% versus beyond BCLC: 70.8%, p = 0.80), with BCLC B/C patients more often having multiple tumors at relapse (69.6% versus 49.4%, p = 0.001) and higher rates of early (< 2 years) recurrence (88.0% versus 75.5%, p = 0.011). During the first postoperative year, annual recurrence was 38.3% and 21.3% among BCLC B/C and BCLC 0/A patients, respectively; 5-year OS among BCLC 0/A and BCLC B/C patients was 76.9% versus 51.6% (p = 0.003). On multivariable analysis, only a-fetoprotein (AFP) > 400 ng/mL (HR = 1.84, 95% CI 1.07–3.15) and R1 resection (HR = 2.36, 95% CI 1.32–4.23) were associated with higher risk of recurrence among BCLC B/C patients.

Conclusions

Surgery can provide acceptable outcomes among select patients with BCLC B/C HCC. The data emphasize the need to further refine the BCLC treatment algorithm as well as highlight the need for surveillance protocols with a particular focus on the liver, especially for patients undergoing resection outside the BCLC criteria.
Appendix
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Metadata
Title
Recurrence Patterns and Outcomes after Resection of Hepatocellular Carcinoma within and beyond the Barcelona Clinic Liver Cancer Criteria
Authors
Diamantis I. Tsilimigras, MD
Fabio Bagante, MD
Dimitrios Moris, MD, PhD
J. Madison Hyer, MS
Kota Sahara, MD
Anghela Z. Paredes, MD, MS
Rittal Mehta, MPH
Francesca Ratti, MD
Hugo P. Marques, MD
Olivier Soubrane, MD
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
01-07-2020
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 7/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-08452-3

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