Letter to the Editor: Hepatic Resection Compared to Chemoembolization in Intermediate‐ to Advanced‐Stage Hepatocellular Carcinoma: A Comment For Moving Forward

Mo, Dun-Chang; Jia, Rongrong; Zhong, Jian‐Hong

doi:10.1002/hep.30409

Cited by 10 publications

(5 citation statements)

References 5 publications

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“…21,22 The current study is one of the largest cohorts of patients undergoing liver resection outside the BCLC criteria (n = 157 patients with BCLC stage B HCC) reported in the literature. 20,23,24 By exclusively analyzing BCLC stage B patients who underwent resection, we were able to determine that the 5-year OS of 49.9% (95% CI 37.8-60.9) was similar to patients having BCLC stage A1 tumors. Thus, the data support surgery as being beneficial in select patients with BCLC stage B HCC.…”

Section: B Amentioning

confidence: 99%

Prognosis After Resection of Barcelona Clinic Liver Cancer (BCLC) Stage 0, A, and B Hepatocellular Carcinoma: A Comprehensive Assessment of the Current BCLC Classification

et al. 2019

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Background. Although the Barcelona Clinic Liver Cancer (BCLC) staging system has been largely adopted in clinical practice, recent studies have questioned the prognostic stratification of this classification schema, as well as the proposed treatment allocation of patients with a single large tumor. Methods. Patients who underwent curative-intent hepatectomy for histologically proven hepatocellular carcinoma (HCC) between 1998 and 2017 were identified using an international multi-institutional database. Overall survival (OS) among patients with BCLC stage 0, A, and B was Electronic supplementary material The online version of this article (

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Section: B Amentioning

confidence: 99%

Prognosis After Resection of Barcelona Clinic Liver Cancer (BCLC) Stage 0, A, and B Hepatocellular Carcinoma: A Comprehensive Assessment of the Current BCLC Classification

et al. 2019

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“…The benefit of surgical resection was noted in all subgroup analyses, including analyses stratified by BCLC stage (BCLC-B, HR = 0.53, 95%CI: 0.43-0.65; BCLC-C, HR = 0.67, 95%CI: 0.59-0.77), as well as study type (RCT + PSM NRCT, HR = 0.65, 95%CI: 0.53-0.78; all studies, HR = 0.59, 95%CI: 0.51-0.67) [10] . Although this meta-analysis further called into question the recommended treatment algorithm proposed by the current BCLC classification schema [10] , it was later criticized for inconsistencies in inclusion criteria/definition of BCLC stages [i.e., 39%-86% of patients had single large tumors (> 5 cm) in the BCLC-B group], overlapping populations among individual studies, as well as sequential treatments offered to patients (i.e., not only surgery or TACE) that prevented a "true" comparison of surgery vs. TACE for intermediate or advanced stage HCC [19,20] . Despite data favoring resection over TACE for select patients with BCLC-B tumors, the majority of available data derive from retrospective analyses that are subject to selection bias.…”

Section: Resection Beyond Bclc Criteria: Is It Justified In Select Patients?mentioning

confidence: 99%

Hepatocellular carcinoma beyond Barcelona clinic liver cancer resection criteria: resecting the aggressive tumor

Tsilimigras¹,

Pawlik²

2021

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According to the Barcelona Clinic Liver Cancer (BCLC) staging system, surgical resection is recommended only for BCLC-0 and BCLC-A hepatocellular carcinoma (HCC). Nevertheless, several investigators have recently advocated for widening the resection criteria for HCC to select patients with BCLC-B and less frequently BCLC-C tumors. The available studies have reported a 5-year survival rate ranging from 25% to 63% following resection of select patients with multinodular HCC. The role of liver resection for macrovascular invasive HCC still remains unclear. The present review aimed to summarize the available evidence regarding the outcomes of patients who underwent resection for BCLC-B/C HCC as well as highlight the proposed criteria for resection beyond the current BCLC guidelines.

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“…Earlier version of the BCLC system classified large solitary HCC beyong 5 cm with an expansive growth as intermediate disease. Namely, intermediate disease definition includes a wide range of patients according to liver function and tumour burden, which triggered a major controversy to further stratify intermediate stage HCC according to tumor burden and liver function [17][18][19] . Nowadays, guideline from European Association for the Study of the Liver [13] and several reviews written by BCLC proponents seems trying to recalibrate their position stating that if technically feasible patients with large solitary HCC beyond 5 cm should be classified as BCLC stage A.…”

Section: Should Postoperative Hcc Patients Receive Adjuvant Treatmmentioning

confidence: 99%

Controversies of hepatectomy and adjuvant therapy for hepatocellular carcinoma: moving forward

Zhong¹,

Xiang²

2019

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Due to the prevelence of hepatitis B virus (HBV) and hepatitis C virus (HCV), occurrence of hepatocellular carcinoma (HCC) is increasing in many countries/regions, including China [1] . HBV and HCV infections, alcohol consumption, non-alcoholic steatohepatitis cirrhosis, or obesity pandemic are risk factors of HCC development. A recent survey study found about 70% patients with HCC are diagnosed as intermediate or advanced disease because of the lack of significant syndrome in their early stage [2] . Main treatments of HCC include hepatectomy, liver transplantation, ablation (radiofrequency, microwave, cryoablation), transarterial chemoembolization, radiotherapy, chemotherapy, target therapy, and so on. Among these treatments, only hepatectomy, liver transplantation, and ablation are curative treatments, with a 70% 5-year overall survival (OS) for early stage HCC. Hepatectomy is not recommended by Western official guidelines for intermediate and advanced stage HCC. However, Eastern official guidelines and many liver centres recommend hepatectomy for such patients who are with preserved liver function. Tumor recurrence, which occurs in 70% within 5 years after hepatectomy, is a major cause of death after hepatectomy [3] . This recurrence can be true recurrence relating to primary tumor (intrahepatic metastases), which occurs less than two years, or it can be due to the development of de novo tumors relating to liver disease (such as HBV/HCV and cirrhosis), which occurs at least two years later. Even so, none Western official guidelines recommend any effective adjuvant therapy to prevent HCC recurrence.Therefore, there are at least three controversies in the field of HCC treatment between literature evidence and official guidelines. Namely: 1. 2. 3. Should postoperative HCC patients receive adjuvant treatments?

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Letter to the Editor: Hepatic Resection Compared to Chemoembolization in Intermediate‐ to Advanced‐Stage Hepatocellular Carcinoma: A Comment For Moving Forward

Cited by 10 publications

References 5 publications

Prognosis After Resection of Barcelona Clinic Liver Cancer (BCLC) Stage 0, A, and B Hepatocellular Carcinoma: A Comprehensive Assessment of the Current BCLC Classification

Prognosis After Resection of Barcelona Clinic Liver Cancer (BCLC) Stage 0, A, and B Hepatocellular Carcinoma: A Comprehensive Assessment of the Current BCLC Classification

Hepatocellular carcinoma beyond Barcelona clinic liver cancer resection criteria: resecting the aggressive tumor

Controversies of hepatectomy and adjuvant therapy for hepatocellular carcinoma: moving forward

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