Treatment Analysis Of Patients With Hepatocellular Carcinoma Beyond BCLC-A

Objective Barcelona Clinic Liver Cancer(BCLC) staging system is the mainstream for hepatocellular carcinoma staging, besides, it presents a detailed proposal for the treatment of hepatocellular carcinoma. However, a growing number of surgeon world widely believe that the therapeutic strategies proposed in BCLC staging system and the indications for surgery management are too strict. So a large number of studies aimed at further refinement of liver cancer staging and enrich the treatment strategy of choice emerged. The main purpose of this study is to analyze the treatment outcome of patients whose therapeutic strategy was beyond the BCLC staging guidelines. Discussion was focused on clinical and pathological prognostic factors of patients in BCLC-B stage,determining who might benefit from surgery in subgroups,in order to find who are suitable for operation.Methods The present study retrospectively analyzed the clinical information of 167 patients with BCLC stage B and C stage hepatocellular carcinoma who were firstly treated in our hospital between January 2009 to December 2010, they all received hepatectomy or selective hepatic artery embolization, and part of the therapeutic strategy are beyond the advice from BCLC staging system. Disease-free survival and overall survival were all analyzed in patients who received liver resection. Postoperative complications were graded by Clavien-Dindo classification. In univariate analysis, all clinical and pathological factors that may have an impact on survival of patients were all included in the test range. Using the Log-rank test methods to verify its impact on the survival, and use multivariate proportional hazards model to analyze the effect on survival of the risk factors in patients with BCLC-B stage hepatocellular carcinoma.Results1. The perioperative morbidity(grade II or higher) rate of all patients with HCC in B stage was 21.1%(n=15). No patient died in during hospitalization.2. Disease free survival rates for patients with stage B in the surgery group, at 1year, 3 years and 5 years were76.1%, 30.9% and 5.6% respectively, the median disease free survival was 26.5 mo(21.3-34.7mo); overall survival rates at 1 year, 3years and 5 years were 84.5%,40.8% and 12.7% respectively, the median overall survival was 32.1mo(25.4-38.6mo), overall survival rates at 1 year, 3 years and 5years of the TACE group were 60.4%,20.8%,and 4.2% respectively, the difference of overall survival between surgery group and TACE group was statistically significant.3. In univariate survival analysis, Age <50, weight loss, PS score = 1,TBIL?17.1?mol/L, PLT <80×l0^9/L, AFP>400?g/L, liver cirrhosis, sum maximum tumor diameter>5cm, the number of tumors> 3, tumor distribution beyond half of the liver were independent unfavorable prognostic factors which affected disease free survival. In multivariate analysis, tumor distribution type and the number of tumor nodules were independent risk factors for disease-free survival prognosis.4. In univariate analysis, age <50, weight loss, PS = 1, TBIL?17.1?mol/L, PLT<80×l0^9/L, AFP>400?g/L, the number of tumor nodules> 3, sum maximum tumor diameter>5cm, tumor distribution beyond half of the liver, liver cirrhosis,intraoperative blood transfusion were independent unfavorable prognostic factors which affected overall survival; in multivariate analysis: weight loss, the number of tumor nodules> 3, intraoperative blood transfusion, the total size of the tumor and tumor distribution types were independent risk factors for overall survival prognosis.5.The difference of overall survival between surgery group and TACE group in the C-stage patients was not statistically significant.Conclusions Surgical indications may be relaxed appropriately for some patient with liver cancer beyond BCLC-A stage; Multivariate analysis showed that weight loss, the number of tumor nodules> 3, intraoperative blood transfusion, distribution type are independent prognostic risk factors of overall survival, B stage patients without these risk factors may benifit from liver resection.