Selection criteria for hepatic resection in intermediate-stage (BCLC stage B) multiple hepatocellular carcinoma
Background Several reports have suggested that hepatic resection provides a survival benefit in patients with hepatocellular carcinoma (HCC) at the intermediate stage of the Barcelona Clinic Liver Cancer classification (BCLC-B). The operative indications for multiple BCLC-B have not been established...
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| creator | Wada, Hiroshi, MD, PhD Eguchi, Hidetoshi, MD, PhD Noda, Takehiro, MD, PhD Ogawa, Hisataka, MD, PhD Yamada, Daisaku, MD, PhD Tomimaru, Yoshito, MD, PhD Tomokuni, Akira, MD, PhD Asaoka, Tadafumi, MD, PhD Kawamoto, Koichi, MD, PhD Gotoh, Kunihito, MD, PhD Marubashi, Shigeru, MD, PhD Umeshita, Koji, MD, PhD Nagano, Hiroaki, MD, PhD Doki, Yuichiro, MD, PhD Mori, Masaki, MD, PhD |
| description | Background Several reports have suggested that hepatic resection provides a survival benefit in patients with hepatocellular carcinoma (HCC) at the intermediate stage of the Barcelona Clinic Liver Cancer classification (BCLC-B). The operative indications for multiple BCLC-B have not been established, however. The aim of this study was to clarify the survival benefit of hepatic resection for multinodular BCLC-B HCC. Methods We retrospectively analyzed 85 patients with BCLC-B HCC who underwent liver resection. To evaluate clinicopathologic factors and survival, we divided the patients into 3 types based on radiologic findings regarding tumor number and maximum tumor diameter: type 1, up to 3 lesions 4 nodules. Results Thirty-four patients were classified as type 1, 32 as type 2, and 19 as type 3. The 1-, 3-, and 5-year survival in type 1 were 97.1%, 87.4%, and 75.2%, respectively. Those in type 2 were 84.0%, 74.0%, and 63.0%, and those in type 3 were 64.9%, 55.7%, and 37.1%, respectively. The overall survival of type 1 patients was significantly better than that of type 3 patients. The prognosis of type 2 patients was worse than that of type 1 patients and better than that of type 3. Multivariate analysis identified radiologic tumor size and tumor number as independent prognostic factors. Conclusion Our findings suggest that hepatic resection should be considered a radical treatment for multinodular BCLC-B HCC. Our subclassification can be applied to select the initial treatment and when making decisions regarding hepatic resection of BCLC-B HCC with multiple nodules. |
| doi_str_mv | 10.1016/j.surg.2016.05.023 |
| format | Article |
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The operative indications for multiple BCLC-B have not been established, however. The aim of this study was to clarify the survival benefit of hepatic resection for multinodular BCLC-B HCC. Methods We retrospectively analyzed 85 patients with BCLC-B HCC who underwent liver resection. To evaluate clinicopathologic factors and survival, we divided the patients into 3 types based on radiologic findings regarding tumor number and maximum tumor diameter: type 1, up to 3 lesions <5 cm; type 2, up to 3 lesions ≥5 cm or 4 nodules of any size; type 3, >4 nodules. Results Thirty-four patients were classified as type 1, 32 as type 2, and 19 as type 3. The 1-, 3-, and 5-year survival in type 1 were 97.1%, 87.4%, and 75.2%, respectively. Those in type 2 were 84.0%, 74.0%, and 63.0%, and those in type 3 were 64.9%, 55.7%, and 37.1%, respectively. The overall survival of type 1 patients was significantly better than that of type 3 patients. The prognosis of type 2 patients was worse than that of type 1 patients and better than that of type 3. Multivariate analysis identified radiologic tumor size and tumor number as independent prognostic factors. Conclusion Our findings suggest that hepatic resection should be considered a radical treatment for multinodular BCLC-B HCC. Our subclassification can be applied to select the initial treatment and when making decisions regarding hepatic resection of BCLC-B HCC with multiple nodules.</description><identifier>ISSN: 0039-6060</identifier><identifier>EISSN: 1532-7361</identifier><identifier>DOI: 10.1016/j.surg.2016.05.023</identifier><identifier>PMID: 27395761</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Analysis of Variance ; Carcinoma, Hepatocellular - mortality ; Carcinoma, Hepatocellular - pathology ; Carcinoma, Hepatocellular - surgery ; Cause of Death ; Cohort Studies ; Disease-Free Survival ; Female ; Follow-Up Studies ; Hepatectomy - methods ; Hepatectomy - mortality ; Humans ; Japan ; Kaplan-Meier Estimate ; Liver Neoplasms - mortality ; Liver Neoplasms - pathology ; Liver Neoplasms - surgery ; Male ; Middle Aged ; Neoplasm Invasiveness - pathology ; Neoplasm Staging ; Patient Selection ; Proportional Hazards Models ; Retrospective Studies ; Risk Assessment ; Statistics, Nonparametric ; Surgery ; Survival Analysis ; Treatment Outcome</subject><ispartof>Surgery, 2016-11, Vol.160 (5), p.1227-1235</ispartof><rights>Elsevier Inc.</rights><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c477t-37f91b0a0aa38ec4ed13ba1cd6878f3b9f8c3a17f115bfc0149e4f7f574f96863</citedby><cites>FETCH-LOGICAL-c477t-37f91b0a0aa38ec4ed13ba1cd6878f3b9f8c3a17f115bfc0149e4f7f574f96863</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0039606016301982$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27395761$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wada, Hiroshi, MD, PhD</creatorcontrib><creatorcontrib>Eguchi, Hidetoshi, MD, PhD</creatorcontrib><creatorcontrib>Noda, Takehiro, MD, PhD</creatorcontrib><creatorcontrib>Ogawa, Hisataka, MD, PhD</creatorcontrib><creatorcontrib>Yamada, Daisaku, MD, PhD</creatorcontrib><creatorcontrib>Tomimaru, Yoshito, MD, PhD</creatorcontrib><creatorcontrib>Tomokuni, Akira, MD, PhD</creatorcontrib><creatorcontrib>Asaoka, Tadafumi, MD, PhD</creatorcontrib><creatorcontrib>Kawamoto, Koichi, MD, PhD</creatorcontrib><creatorcontrib>Gotoh, Kunihito, MD, PhD</creatorcontrib><creatorcontrib>Marubashi, Shigeru, MD, PhD</creatorcontrib><creatorcontrib>Umeshita, Koji, MD, PhD</creatorcontrib><creatorcontrib>Nagano, Hiroaki, MD, PhD</creatorcontrib><creatorcontrib>Doki, Yuichiro, MD, PhD</creatorcontrib><creatorcontrib>Mori, Masaki, MD, PhD</creatorcontrib><title>Selection criteria for hepatic resection in intermediate-stage (BCLC stage B) multiple hepatocellular carcinoma</title><title>Surgery</title><addtitle>Surgery</addtitle><description>Background Several reports have suggested that hepatic resection provides a survival benefit in patients with hepatocellular carcinoma (HCC) at the intermediate stage of the Barcelona Clinic Liver Cancer classification (BCLC-B). The operative indications for multiple BCLC-B have not been established, however. The aim of this study was to clarify the survival benefit of hepatic resection for multinodular BCLC-B HCC. Methods We retrospectively analyzed 85 patients with BCLC-B HCC who underwent liver resection. To evaluate clinicopathologic factors and survival, we divided the patients into 3 types based on radiologic findings regarding tumor number and maximum tumor diameter: type 1, up to 3 lesions <5 cm; type 2, up to 3 lesions ≥5 cm or 4 nodules of any size; type 3, >4 nodules. Results Thirty-four patients were classified as type 1, 32 as type 2, and 19 as type 3. The 1-, 3-, and 5-year survival in type 1 were 97.1%, 87.4%, and 75.2%, respectively. Those in type 2 were 84.0%, 74.0%, and 63.0%, and those in type 3 were 64.9%, 55.7%, and 37.1%, respectively. The overall survival of type 1 patients was significantly better than that of type 3 patients. The prognosis of type 2 patients was worse than that of type 1 patients and better than that of type 3. Multivariate analysis identified radiologic tumor size and tumor number as independent prognostic factors. Conclusion Our findings suggest that hepatic resection should be considered a radical treatment for multinodular BCLC-B HCC. Our subclassification can be applied to select the initial treatment and when making decisions regarding hepatic resection of BCLC-B HCC with multiple nodules.</description><subject>Adult</subject><subject>Aged</subject><subject>Analysis of Variance</subject><subject>Carcinoma, Hepatocellular - mortality</subject><subject>Carcinoma, Hepatocellular - pathology</subject><subject>Carcinoma, Hepatocellular - surgery</subject><subject>Cause of Death</subject><subject>Cohort Studies</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hepatectomy - methods</subject><subject>Hepatectomy - mortality</subject><subject>Humans</subject><subject>Japan</subject><subject>Kaplan-Meier Estimate</subject><subject>Liver Neoplasms - mortality</subject><subject>Liver Neoplasms - pathology</subject><subject>Liver Neoplasms - surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasm Invasiveness - pathology</subject><subject>Neoplasm Staging</subject><subject>Patient Selection</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Statistics, Nonparametric</subject><subject>Surgery</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><issn>0039-6060</issn><issn>1532-7361</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUFv1DAQhS0EosvCH-CAciyHhJk4sRMJIbUroJVW6qHlbDnecfGSxIudIPXf4ygLBw5I1nikee_J_oaxtwgFAooPxyLO4bEoU19AXUDJn7EN1rzMJRf4nG0AeJsLEHDBXsV4BIC2wuYluyglb2spcMP8PfVkJufHzAQ3UXA6sz5k3-mkJ2eyQPE8dstJgoEOTk-Ux0k_UnZ5vdvvsrW_fp8Ncz-5U0-r3xvq-7nXITM6GDf6Qb9mL6zuI70531v27cvnh91Nvr_7eru72uemknLKubQtdqBBa96QqeiAvNNoDqKRjeVdaxvDNUqLWHfWAFYtVVbaWla2FY3gW3a55p6C_zlTnNTg4vIcPZKfo8KmFDKVBG3LylVqgo8xkFWn4AYdnhSCWkCro1pAqwW0glolTzK9O-fPXSLy1_KHbBJ8XAWUfvnLUVDROBpNohcSUXXw7v_5n_6xm96Nzuj-Bz1RPPo5jImfQhVLBep-WfWyaRQcsG1K_hvnbqVX</recordid><startdate>20161101</startdate><enddate>20161101</enddate><creator>Wada, Hiroshi, MD, PhD</creator><creator>Eguchi, Hidetoshi, MD, PhD</creator><creator>Noda, Takehiro, MD, PhD</creator><creator>Ogawa, Hisataka, MD, PhD</creator><creator>Yamada, Daisaku, MD, PhD</creator><creator>Tomimaru, Yoshito, MD, PhD</creator><creator>Tomokuni, Akira, MD, PhD</creator><creator>Asaoka, Tadafumi, MD, PhD</creator><creator>Kawamoto, Koichi, MD, PhD</creator><creator>Gotoh, Kunihito, MD, PhD</creator><creator>Marubashi, Shigeru, MD, PhD</creator><creator>Umeshita, Koji, MD, PhD</creator><creator>Nagano, Hiroaki, MD, PhD</creator><creator>Doki, Yuichiro, MD, PhD</creator><creator>Mori, Masaki, MD, PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20161101</creationdate><title>Selection criteria for hepatic resection in intermediate-stage (BCLC stage B) multiple hepatocellular carcinoma</title><author>Wada, Hiroshi, MD, PhD ; 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The operative indications for multiple BCLC-B have not been established, however. The aim of this study was to clarify the survival benefit of hepatic resection for multinodular BCLC-B HCC. Methods We retrospectively analyzed 85 patients with BCLC-B HCC who underwent liver resection. To evaluate clinicopathologic factors and survival, we divided the patients into 3 types based on radiologic findings regarding tumor number and maximum tumor diameter: type 1, up to 3 lesions <5 cm; type 2, up to 3 lesions ≥5 cm or 4 nodules of any size; type 3, >4 nodules. Results Thirty-four patients were classified as type 1, 32 as type 2, and 19 as type 3. The 1-, 3-, and 5-year survival in type 1 were 97.1%, 87.4%, and 75.2%, respectively. Those in type 2 were 84.0%, 74.0%, and 63.0%, and those in type 3 were 64.9%, 55.7%, and 37.1%, respectively. The overall survival of type 1 patients was significantly better than that of type 3 patients. The prognosis of type 2 patients was worse than that of type 1 patients and better than that of type 3. Multivariate analysis identified radiologic tumor size and tumor number as independent prognostic factors. Conclusion Our findings suggest that hepatic resection should be considered a radical treatment for multinodular BCLC-B HCC. Our subclassification can be applied to select the initial treatment and when making decisions regarding hepatic resection of BCLC-B HCC with multiple nodules.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27395761</pmid><doi>10.1016/j.surg.2016.05.023</doi><tpages>9</tpages></addata></record> |
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| subjects | Adult Aged Analysis of Variance Carcinoma, Hepatocellular - mortality Carcinoma, Hepatocellular - pathology Carcinoma, Hepatocellular - surgery Cause of Death Cohort Studies Disease-Free Survival Female Follow-Up Studies Hepatectomy - methods Hepatectomy - mortality Humans Japan Kaplan-Meier Estimate Liver Neoplasms - mortality Liver Neoplasms - pathology Liver Neoplasms - surgery Male Middle Aged Neoplasm Invasiveness - pathology Neoplasm Staging Patient Selection Proportional Hazards Models Retrospective Studies Risk Assessment Statistics, Nonparametric Surgery Survival Analysis Treatment Outcome |
| title | Selection criteria for hepatic resection in intermediate-stage (BCLC stage B) multiple hepatocellular carcinoma |
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