Detailed Abstract
[Liver Oral Presentation 1 - Liver (Liver Disease/Surgery)]
[LV OP 1-S7] Resectability in BCLC Stage B HCC: a Prognostic Pivot Beyond Current Guidelines
Minseob KIM 1, YoungRok CHOI 1, Jeong-Moo LEE 1, Kyung Chul YOON 2, Sanggyun SUH 3
1 Department of Surgery, Seoul National University Hospital, REPUBLIC OF KOREA, 2 Department of Surgery, Seoul National University Boramae Medical Center, REPUBLIC OF KOREA, 3 Department of Surgery, Chung-Ang University Hospital, REPUBLIC OF KOREA
Background : Despite the 2022 guidelines, Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC) patients predominantly continue to receive non-surgical interventions as their primary therapeutic modality. The prevailing recommendations do not encompass curative surgical interventions, leading to ongoing debates regarding the optimal treatment approach. This study evaluates the impact of HCC resectability on prognosis in these patients.
Methods : Four expert liver surgeons independently and blindly assessed the resectability on 1,342 HCC patients who underwent initial treatment and subsequently monitored at a single tertiary center between 2015 and 2017. Patients were categorized based on resectability. Subsequent retrospective analyses on EMR data were conducted to discern prognostic indicators and associated factors.
Results : Of 223 BCLC stage B patients, 130 were deemed resectable by at least one surgeon, while 93 were considered unresectable. The resectable cohort exhibited 1-year and 3-year survival rates of 97.4% and 91.3%, respectively, versus 83.3% and 73.2% in the unresectable group (P<0.001). Among resectables group, 15.4% underwent surgery, 80.8% received TACE or TARE, 6.9% had liver transplantation, and 1.5% underwent RFA. Resectable group showed a favorable survival trend with surgery over TACE (P=0.075). Multivariate analysis revealed surgical candidacy (adjusted HR 0.29, P<0.001), higher albumin (aHR 0.41, P<0.001), female gender (aHR 0.11, P<0.032), and PIVKA<2412.5 (aHR 0.29, P<0.001) as significant survival determinants.
Conclusions : HCC resectability assessment plays a crucial role in intermediate stage HCC prognosis. Surgical resection emerges as a pivotal intervention, suggesting that curative treatment objectives might be achievable for select patient subgroups in BCLC B.
Methods : Four expert liver surgeons independently and blindly assessed the resectability on 1,342 HCC patients who underwent initial treatment and subsequently monitored at a single tertiary center between 2015 and 2017. Patients were categorized based on resectability. Subsequent retrospective analyses on EMR data were conducted to discern prognostic indicators and associated factors.
Results : Of 223 BCLC stage B patients, 130 were deemed resectable by at least one surgeon, while 93 were considered unresectable. The resectable cohort exhibited 1-year and 3-year survival rates of 97.4% and 91.3%, respectively, versus 83.3% and 73.2% in the unresectable group (P<0.001). Among resectables group, 15.4% underwent surgery, 80.8% received TACE or TARE, 6.9% had liver transplantation, and 1.5% underwent RFA. Resectable group showed a favorable survival trend with surgery over TACE (P=0.075). Multivariate analysis revealed surgical candidacy (adjusted HR 0.29, P<0.001), higher albumin (aHR 0.41, P<0.001), female gender (aHR 0.11, P<0.032), and PIVKA<2412.5 (aHR 0.29, P<0.001) as significant survival determinants.
Conclusions : HCC resectability assessment plays a crucial role in intermediate stage HCC prognosis. Surgical resection emerges as a pivotal intervention, suggesting that curative treatment objectives might be achievable for select patient subgroups in BCLC B.
SESSION
Liver Oral Presentation 1
Room A 3/21/2024 3:30 PM - 4:30 PM