The Hepatectomy Surival Benefit Evaluation And Prognosis Factors Analysis Of BCLC-B/C Hepatocellular Carcinoma Patients

Part1The efficacy of hepatic resection compared to transarterialchemoembolization for intermediate and advanced hepatocellularcarcinomaBackground and Objective: Nowadays, different internationalguidelines about the treatment of hepatocellular carcinoma (HCC)recommend different treatment modalities for Barcelona Clinic LiverCancer (BCLC) B and C stage HCC. This study explored the efficacy andsafety of hepatic resection for BCLC-B/C HCC based on our cohort studyand systematic review. Methods: Between2000and2007, a consecutive sample of1259patients with BCLC stage B/C HCC who underwent HR (n=908) ortransarterial chemoembolization (TACE, n=351) were included.Moreover, propensity score-matched patients were analyzed to adjust forany baseline differences. Primary outcomes were overall survival andrecurrence rates. Secondary outcome was adverse event. In parallel withthis retrospective clinical study, the PubMed database was systematicallysearched for studies evaluating the efficacy and safety of HR forBCLC-B/C HCC.Results: Among our patient sample, the30-and90-day mortalityrates in the HR group were1.9%and3.1%. The morbidity rate of HRgroup (27%) was significantly higher than TACE group (19%, P=0.005).However, HR provided a survival benefit over TACE at1,3, and5years(88%vs81%,62%vs33%, and39%vs16%, respectively; P<0.001).Propensity scoring and subgroup analyses based on tumor size, tumornumber, presence or absence of macrovascular invasion, and portalhypertension (PHT) also showed that HR was associated with betterlong-term survival than TACE. The1,3, and5years recurrence rate ofHR group patient was32%,58%and74%. All36studies identified in ourliterature search reported that HR is associated with good long-termsurvival and low mortality. Multivariate analyses revealed thatalpha-fetoprotein≥400ng/mL, diabetes mellitus, macrovascular invasion, and PHT are independent predictors of poor prognosis in patients withBCLC stage B/C HCC.Conclusions: Our clinical and literature analyses suggest that inpatients with HCC with Child-Pugh A liver function, the presence of large,solitary tumors, multinodular tumors, macrovascular invasion, or PHT arenot contraindications for HR. For patients with BCLC-B/C HCC, HRprovides better survival than TACE. Part2Liver resection for patients with hepatocellular carcinoma and portalhypertensionBackground and Aim: The proportion of hepatocellular carcinoma(HCC) patients with cirrhosis and portal hypertension (PHT) is high. PHTmay increase the risk of hemorrhage and liver failure. The aim of thisstudy is to evaluate the safety and efficacy of hepatic resection (HR) forpatients with HCC and PHT.Methods: From2000to2008, a total of564HCC patients withChild-Pugh A liver function and with (78) or without PHT (486) wereretrospective analysis. Morbidity,90-days mortality, overall survival (OS), and recurrence rates were compared between the two groups. Propensityscore analysis was also conducted to reduce confounding bias betweenthe groups. Moreover, subgroup analysis based on tumor stage and therange of resection was carried out.Results: The morbidity and90-days mortality of patients withPHT were significantly higher than those without PHT, before and afterpropensity analysis (P<0.05). After an average follow-up of32.1months,the1-,3-,5-year OS of patients with PHT (75%,45%and32%) wassignificantly worse than those without PHT (90%,66%and48%;P<0.001). However, the1-,3-, and5-year recurrence rates were similarbetween PHT group (31%,57%, and73%) and without PHT group (26%,53%, and67%; P=0.53). Moreover, the OS of the two groups weresimilar after propensity analysis, and for patients with early stage HCCand those who underwent minor hepatectomy (all P>0.05).Conclusion: PHT is not the contraindication of HR for patientswith HCC. Those with early stage HCC and who underwent minorhepatectomy are the best candidates to HR therapy.