Individualized Approach in the Surgical Management of Hepatocellular Carcinoma: Results from a Greek Multicentre Study

Abstract

Background: Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the third leading cause of death worldwide. The management of HCC is complex, with surgical treatment providing long-term survival in eligible patients. This study aims to present the experience of aggressive surgical management of HCC in Greece. Methods: This is a retrospective multicentre clinical study with 242 patients. Results: Most patients were male (79%) and had a median age of 71 yrs. According to the most recent BCLC criteria, 172 patients (71.1%) were classified as BCLC 0-A stage, 33 patients (13.6%) were classified as BCLC B, and 37 (15.3%) were classified as BCLC C. A total of 54% of the patients underwent major hepatectomy. Major postoperative morbidity was 15.6%, and the 90-day postoperative mortality rate was 4.5%. The median follow-up was 33.5 months. Three- and five-year overall survival was 65% and 48%, respectively. The median overall survival was 55 months. Significantly, five-year survival was 55% for BCLC A, and 34% and 21% for BCLC B and C, respectively. In univariate analysis, cirrhosis, type of resection (R status), and BCLC stage were associated with overall survival. Multivariate analysis indicated that R1 and R2 resections compared to R0, and BCLC C compared to BCLC 0-A, were independently associated with increased mortality. Conclusions: Aggressive surgical treatment of HCC offers satisfactory long-term survival prospects. A significant percentage (29%) of HCCs that underwent liver resection were of the intermediate and advanced BCLC stage. The management of patients with HCC should be discussed in multidisciplinary tumour board meetings on a case-by-case basis to be more effective.

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

“…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).…”

A cellular senescence-related genes model allows for prognosis and treatment stratification of hepatocellular carcinoma: A bioinformatics analysis and experimental verification

“…In 2018, the number of new cases of liver cancer worldwide reached 840,000, ranking seventh among all malignant tumors ( Bray et al, 2018 ). At present, the clinical treatment of HCC is mainly surgery, combined with interventional therapy, radiotherapy, and chemotherapy, targeted drugs and other treatment methods ( Glantzounis et al, 2022 ). Despite immunotherapy for HCC patients has made great progress ( Hu et al, 2022 ; Zhu et al, 2022 ), HCC patients still have a high recurrence and metastasis rate and low 5-year survival rate ( Miyata et al, 2022 ; Reveron-Thornton et al, 2022 ).…”