Extending Surgical Resection for Hepatocellular Carcinoma Beyond Barcelona Clinic for Liver Cancer (BCLC) Stage A: A Novel Application of the Modified BCLC Staging System

Wee, Ian; Moe, Fiona Ni Ni; Sultana, Rehena; Ang, Reiko; Quek, Pearly PS; Goh, Brian K. P.; Chan, Chung Yip; Cheow, Peng Chung; Chung, Alexander Y. F.; Jeyaraj, Prema Raj; Koh, Ye Xin; Mack, Peter OP; Ooi, London Lucien PJ; Tan, Ek Khoon; Teo, Jin Yao; Kam, Juinn Huar; Chua, Jacelyn SS; Ng, Ashley; Goh, Jade SQ; Chow, Pierce K. H.

doi:10.2147/jhc.s370212

Cited by 12 publications

(7 citation statements)

References 46 publications

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“…Nevertheless, even in patients who are considered to be ideal candidates for curative treatment, the recurrence rates following resection or ablation have been documented to exceed 70% within five years ( 52 ). Furthermore, in patients with more advanced tumor burden undergoing curative-intent therapies, the risk of HCC recurrence is further amplified ( 53 , 54 ). The present study focused on patients with intermediate and advanced-stage HCC who underwent curative-intent surgical resection, and attempted to highlight the potential benefits of adjuvant immunotherapy in a cohort of patients that Western guidelines might consider non-operable.…”

Section: Discussionmentioning

confidence: 99%

Adjuvant immunotherapy improves recurrence-free and overall survival following surgical resection for intermediate/advanced hepatocellular carcinoma a multicenter propensity matching analysis

Xu,

Wang,

et al. 2024

Front. Immunol.

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Background & aimsThe effectiveness of adjuvant immunotherapy to diminish recurrence and improve long-term prognosis following curative-intent surgical resection for hepatocellular carcinoma (HCC) is of increased interest, especially among individuals at high risk of recurrence. The objective of the current study was to investigate the impact of adjuvant immunotherapy on long-term recurrence and survival after curative resection among patients with intermediate/advanced HCC.MethodsUsing a prospectively-collected multicenter database, patients who underwent curative-intent resection for Barcelona Clinic Liver Cancer (BCLC) stage B/C HCC were identified. Propensity score matching (PSM) analysis was used to compare recurrence-free survival (RFS) and overall survival (OS) between patients treated with and without adjuvant immune checkpoint inhibitors (ICIs). Multivariate Cox-regression analysis further identified independent factors of RFS and OS.ResultsAmong the 627 enrolled patients, 109 patients (23.3%) received adjuvant immunotherapy. Most ICI-related adverse reactions were grading I-II. PSM analysis created 99 matched pairs of patients with comparable baseline characteristics between patients treated with and without adjuvant immunotherapy. In the PSM cohort, the median RFS (29.6 vs. 19.3 months, P=0.031) and OS (35.1 vs. 27.8 months, P=0.036) were better among patients who received adjuvant immunotherapy versus patients who did not. After adjustment for other confounding factors on multivariable analyzes, adjuvant immunotherapy remained independently associated with favorable RFS (HR: 0.630; 95% CI: 0.435-0.914; P=0.015) and OS (HR: 0.601; 95% CI: 0.401-0.898; P=0.013). Subgroup analyzes identified potentially prognostic benefits of adjuvant immunotherapy among patients with intermediate-stage and advanced-stage HCC.ConclusionThis real-world observational study demonstrated that adjuvant immunotherapy was associated with improved RFS and OS following curative-intent resection of intermediate/advanced HCC. Future randomized controlled trials are warranted to establish definitive evidence for this specific population at high risks of recurrence.

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Section: Discussionmentioning

confidence: 99%

Adjuvant immunotherapy improves recurrence-free and overall survival following surgical resection for intermediate/advanced hepatocellular carcinoma a multicenter propensity matching analysis

Xu,

Wang,

et al. 2024

Front. Immunol.

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“…The BCLC system, which is widely accepted for HCC staging and the treatment selection (16), does not recommend hepatectomy for stage B disease patients. However, several studies have suggested that potentially curative treatments, such as resection, can be safe and effective for stage B disease patients (17)(18)(19). However, the use of TACE in BCLC-B patients has been questioned in recent years (20).…”

Section: Discussionmentioning

confidence: 99%

“…In China, HCC is predominantly related to chronic infection with the hepatitis B virus, and often co-occurs with cirrhosis. A previous study showed that many patients with stage B disease who meet the up-to-7 criterion are treated with hepatectomy, which may lead to surprising improvements in OS ( 17 ).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the up-to-7 criterion for determining the treatment of hepatocellular carcinoma in Barcelona Clinic Liver Cancer stage B: a single-center retrospective cohort study

Xiao¹,

Zhang²,

Xie³

et al. 2023

J Gastrointest Oncol

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Background: At present, there are still disputes on the treatment of surgery for patients with stage B hepatocellular carcinoma (HCC). This study sought to investigate whether the up-to-7 criterion could be used to decide the treatment for HCC in Barcelona Clinic Liver Cancer stage B (BCLC-B). Methods:We analyzed 340 patients with HCC in BCLC-B who treated with hepatectomy or transcatheter arterial chemoembolization (TACE). Of the 285 HCC patients who underwent hepatectomy, 108 met the up-to-7 criterion and 177 exceeded it. All 55 patients in the TACE group met the up-to-7 criterion. We obtained the tumor status of the patients through inpatient medical records, outpatient medical records, and telephone follow-up of the hospital. We compared overall survival (OS) and progression-free survival (PFS) were compared between patients who met the up-to-7 criterion and who underwent either hepatectomy or TACE. OS and recurrence time were also compared between the patients who were treated with hepatectomy and who either met or exceeded the up-to-7 criterion. Across BCLC-B patients, we compared the OS of patients after surgical treatment between subgroups stratified by tumor number and diameter.Results: Patients who met the up-to-7 criterion had significantly higher OS rates after hepatectomy than TACE (P<0.001). However, the 2 groups did not differ in terms of PFS (P=0.758). Among the patients treated by hepatectomy, the OS rates were significantly higher in patients who met the up-to-7 criterion than in those who exceeded it (P=0.001). The recurrence rates did not differ between patients who met or exceeded the criterion (P=0.662). OS was significantly higher in patients with ≤3 tumors than those with >3 tumors (P=0.001). When we stratified patients with ≤3 tumors based in whether they met or exceeded the up-to-8 to up-to-15 criterion, OS was significantly better among those who met the criterion in all cases.Conclusions: Hepatectomy appears to be associated with better survival than TACE in patients with BCLC-B HCC who meet the up-to-7 criterion, but this criterion is not a strict indication for deciding whether to treat patients with BCLC-B surgically. Tumor number strongly affects the prognosis of BCLC-B patients after hepatectomy.

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“…A recent study by Wee et al showed that surgical resection treatment can also be taken into consideration for BCLC system patients who are in the intermediate stage and fall outside of BCLC A. This is because BCLC B, those who meet the "Up-To-7" criteria and its subgroups have 5-year overall survival rates that are higher than 50% [21]. However, Roayaie et al discovered that as a result of the processes that underpin the growth of intra-and extrahepatic recurrence, up to 70% of patients experience a disease recurrence in the first five years after a margin-free surgical resection [22].…”

Section: Surgerymentioning

confidence: 99%

Therapeutic options in hepatocellular carcinoma: a comprehensive review

et al. 2023

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Hepatocellular carcinoma (HCC) is a chronic liver disease that is highly fatal if not detected and treated early. The incidence and death rate of HCC have been increasing in recent decades despite the measures taken for preventive screening and effective diagnostic and treatment strategies. The pathophysiology of HCC is multifactorial and highly complex owing to its molecular and immune heterogeneity, and thus the gap in knowledge still precludes making choices between viable therapeutic options and also the development of effective regimens. The treatment of HCC demands multidisciplinary approaches and primarily depends on tumor stage, hepatic functional reserve, and response to treatment by patients. Although curative treatments are limited but critical in the early stages of cancer, there are numerous palliative treatments available for patients with intermediate and advanced-stage HCC. In recent times, the use of combination therapy has succeeded over the use of monotherapy in the treatment of HCC by achieving effective tumor suppression, increasing survival rate, decreasing toxicity, and also aiding in overcoming drug resistance. This work focuses on reviewing the current and emerging treatment strategies for HCC.

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Extending Surgical Resection for Hepatocellular Carcinoma Beyond Barcelona Clinic for Liver Cancer (BCLC) Stage A: A Novel Application of the Modified BCLC Staging System

Cited by 12 publications

References 46 publications

Adjuvant immunotherapy improves recurrence-free and overall survival following surgical resection for intermediate/advanced hepatocellular carcinoma a multicenter propensity matching analysis

Adjuvant immunotherapy improves recurrence-free and overall survival following surgical resection for intermediate/advanced hepatocellular carcinoma a multicenter propensity matching analysis

Evaluation of the up-to-7 criterion for determining the treatment of hepatocellular carcinoma in Barcelona Clinic Liver Cancer stage B: a single-center retrospective cohort study

Therapeutic options in hepatocellular carcinoma: a comprehensive review

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