Surgical Resection Is Superior to TACE in the Treatment of HCC in a Well Selected Cohort of BCLC-B Elderly Patients—A Retrospective Observational Study

Abstract

Hepatocellular carcinoma (HCC) usually develops in cirrhotic liver, with high recurrence rates. However, considering its increasing detection in non-cirrhotic liver, the choice of treatment assumes particular relevance. This study aimed to investigate outcomes of patients among BCLC stages and enrolled for surgical resection (SR) according to a more complex evaluation, to establish its safety and efficacy. A total of 186 selected HCC patients (median age 73.2 yrs), submitted to SR between January 2005 and January 2021, were retrospectively analyzed. Of which, 166 were staged 0, A, B according to the BCLC system, while 20 with a single large tumor (>5 cm) were classified as stage AB. No perioperative mortality was recorded; complications occurred in 48 (25.80%) patients, and all but two were Clavien–Dindo grade I–II. Median follow-up was 9.2 years. Subsequently, 162 recurrent patients (87,1%) were selected for new treatments. Comparable overall survival rates (OS) were observed at 1, 3, 5, and 10 years in 0, A, B and AB stages (p = 0.2). Eventually, the BCLC-B group was matched to 40 BCLC-B patients treated (2015-2021) with TACE. Significant differences in baseline characteristics (p <0.0001) and in OS were observed at 1 and 3 years (p <0.0001); a significant difference was also observed in oncological outcomes, in terms of the absence, residual, or relapse of disease (p <0.05). Surgery might be a valid treatment in HCC for patients affected by chronic liver disease in a condition of compensation, up to BCLC-B stage. Surgical indication for liver resection in case of HCC should be extensively revised.

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).…”

Developing and validating a nomogram based on skeletal muscle index and clinical scoring system for prediction of liver failure after hepatectomy

“…Child-Pugh grade A and B, indocyanine green retention rate at 15 min of 20-30%, and the estimated remnant liver volume of≥35% are listed as prerequisites for resection. Locoregional therapy such as bland hepatic artery embolization, transarterial chemoembolization, and drug-eluting bead transarterial chemoembolization, were used for patients with advanced or unresectable disease who are not surgical candidates (11)(12)(13).…”