Surgical resection improves long-term survival of patients with hepatocellular carcinoma across different Barcelona Clinic Liver Cancer stages
Authors Guo H, Wu T, Lu Q, Li M, Guo JY, Shen Y, Wu Z, Nan KJ, Lv Y, Zhang XF
Received 27 September 2017
Accepted for publication 25 December 2017
Published 21 February 2018 Volume 2018:10 Pages 361—369
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Professor Nakshatri
Hui Guo,1,2 Tao Wu,2 Qiang Lu,1,3 Miaojing Li,2 Jing-Yue Guo,2 Yuan Shen,4 Zheng Wu,1,3 Ke-Jun Nan,2 Yi Lv,1,3 Xu-Feng Zhang1,3
1Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China; 2Department of Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China; 3Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China; 4Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
Objectives: Surgical resection remains a controversial treatment for hepatocellular carcinoma (HCC) within different Barcelona Clinic Liver Cancer (BCLC) stages. The objective of this study was to evaluate the long-term outcome of patients undergoing surgical resection (SR) compared to non-surgical treatments across different BCLC stages.
Patients and methods: One thousand four hundred forty-three HCC patients within BCLC 0, A, B and C stages were identified. Overall survival was compared by log-rank test among patients within different BCLC stages and among patients receiving different treatments (SR vs locoregional therapy [LRT] vs best supportive care). Propensity score matching analysis was introduced to mitigate the confounding biases between the groups.
Results: The median survival time of the patients diminished from early, intermediate to advanced BCLC stages (BCLC 0-A 43 [range 0–100] months vs BCLC B 32 [range 0–100] months vs BCLC C 27 [range 0–90] months, all p<0.05). Patients undergoing SR presented with better liver function and more favorable tumor status and, consequently, displayed significant better overall survival than patients receiving LRT or best supportive care at different BCLC stages. In adjusted cohort after propensity score matching, patients who were surgically treated consistently had more favorable outcome than those who were non-curatively treated across different BCLC stages (median survival [range]: BCLC stage B: resection 45 [0–100] months vs LRT 36 [0–81] months, p=0.002; BCLC stage C: resection 39 [3–77] months vs LRT 27 [0–54] months, p=0.003).
Conclusion: Surgical resection should be considered as a radical treatment for selected HCC patients regardless of the BCLC stages when appropriate.
Keywords: hepatocellular carcinoma, surgery, Barcelona Clinic Liver Cancer stages, outcome
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