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Surgical resection for advanced hepatocellular carcinoma according to Barcelona Clinic Liver Cancer (BCLC) staging

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Abstract

Purpose

The BCLC staging classification has been widely endorsed to predict the prognosis of patients with HCC. However, its validity as a means of therapeutic instructions needs to be challenged. This study aimed to evaluate perioperative and long-term outcomes of surgical resection in patients with advanced hepatocellular carcinoma (HCC) according to the Barcelona Clinic Liver Cancer (BCLC) staging.

Methods

This study used a prospectively maintained database consisting of a consecutive series of 511 Chinese patients with advanced HCC who underwent surgical resection in a hepatobiliary surgical center from 2001 to 2007. Mortality, morbidity, long-term overall survival (OS) and disease-free survival (DFS) were evaluated.

Results

Hospital mortality was 2.3%, and overall morbidity was 31.3%. After a median follow-up period of 27.8 months (range, 0–112 months), the 1-, 3- and 5-year OS rate was 69.9, 41.2 and 30.5%, and the 1-, 3- and 5-year DFS rate was 48.2, 30.3 and 24.0%, respectively. The 1-, 3- and 5-year OS and DFS rates were significantly poorer in patients with vascular invasion and/or extrahepatic spread than those in patients without (both P < 0.001), and also poorer in patients with biliary invasion than those in patients without (both P < 0.05).

Conclusions

Surgical resection could be considered in part of patients with advanced HCC (BCLC stage C), with low mortality, acceptable morbidity and favorable survival benefits. These results imply that BCLC recommendations for treatment schedules of advanced HCC need to be re-evaluated.

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Abbreviations

HCC:

Hepatocellular carcinoma

BCLC:

Barcelona Clinic Liver Cancer

VI:

Vascular invasion

ES:

Extrahepatic spread

PS:

Performance status

ECOG:

Eastern Cooperative Oncology Group

TACE:

Transarterial chemoembolization

CT:

Computed tomography

MRI:

Magnetic resonance imaging

PEI:

Percutaneous ethanol injection

AFP:

Alpha-fetoprotein

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Acknowledgments

The authors thank Dr S.-X. Zhang (Department of College Medical English, Second Military Medical University) for polishing assistance. This study is supported by National Natural Science Foundation for Youths of China (No. 81000166), National Natural Science Foundation of China (No. 81172020), Shanghai Guiding Program of Science and Technology Development Commission Foundation (No. 10411963300), Shanghai Program for Excellent Talents in Health System (No. XYQ2011033) and Shanghai Foundation for Youths of Health Bureau (No. ab8307000-2010-92).

Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, Shanghai, 200438, China

    Tian Yang, Chuan Lin, Jian Zhai, Song Shi, Nan Zhu, Jun-Hua Lu, Guang-Shun Yang & Meng-Chao Wu

  2. Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China

    Min Zhu

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  1. Tian Yang
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  2. Chuan Lin
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  3. Jian Zhai
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  4. Song Shi
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  5. Min Zhu
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  6. Nan Zhu
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  7. Jun-Hua Lu
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Correspondence to Meng-Chao Wu.

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All authors contributed equally to this work.

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Yang, T., Lin, C., Zhai, J. et al. Surgical resection for advanced hepatocellular carcinoma according to Barcelona Clinic Liver Cancer (BCLC) staging. J Cancer Res Clin Oncol 138, 1121–1129 (2012). https://doi.org/10.1007/s00432-012-1188-0

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  • DOI: https://doi.org/10.1007/s00432-012-1188-0

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