Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, China
Han Liu , Zhong-Qi Fan , Ming-Da Wang , Matteo Serenari , Myron Schwartz , Zhong Chen , Ya-Hao Zhou , Xian-Ming Wang , Ting-Hao Chen , Jie Li , Cheng-Wu Zhang , Hong Wang , Wei-Min Gu , Ying-Jian Liang , Matteo Cescon , Guo-Yue Lv , Tian Yang
Background: The role of hepatic resection in treating Barcelona Clinic Liver Cancer (BCLC) intermediate-stage hepatocellular carcinoma (HCC) is a subject of ongoing debate. This study aims to assess the prognostic significance of the number of nodular HCC in patients undergoing hepatic resection for intermediate-stage (BCLC stage B) HCC. Methods: An analysis was conducted using data from a multicenter database of patients who underwent curative-intent resection for BCLC intermediate-stage HCC. Patients were classified into binodular and tri(+)nodular (≥ 3 nodules) groups based on the number of tumor nodules. Long-term overall survival (OS) and recurrence-free survival (RFS) were compared between these groups. Univariate and multivariate Cox-regression analyses identified risk factors for OS and RFS. Additional comparisons were made with outcomes in patients with uninodular large HCC (single nodule > 5 cm; BCLC stage A). Results: Of the 338 patients with BCLC intermediate-stage HCC, 187 (55.3%) had binodular and 151 (44.7%) had tri(+)nodular disease. Patients with binodular HCC showed significantly better median OS (49.6 months) and RFS (22.2 months) compared to those with tri(+)nodular HCC (33.5 and 13.7 months, P = 0.036 and 0.009, respectively), and outcomes comparable to those with uninodular large HCC (59.8 and 26.8 months, P = 0.144 and 0.311, respectively). Multivariate analyses indicated that binodular HCC was independently associated with improved OS and RFS following hepatic resection in BCLC intermediate-stage HCC. Conclusions: Patients with binodular HCC exhibit more favorable survival outcomes post-resection of BCLC intermediate-stage HCC compared to those with tri(+)nodular HCC, akin to outcomes observed in BCLC early-stage uninodular large HCC. These findings highlight the prognostic relevance of nodular number in stratifying and guiding surgical decisions for intermediate-stage HCC.
N (%) | Total (n = 338) | Binodular Group (n = 187) | Tri(+)nodular Group (n = 151) | P |
---|---|---|---|---|
Death during the follow-up | 226 (66.9) | 120 (64.2) | 106 (70.2) | 0.248 |
Recurrence during the follow-up | 215 (63.6) | 114 (61.0) | 101 (66.9) | 0.306 |
Median OS (95% CI), months | 41.7 (31.9, 51.5) | 49.6 (39.3, 59.9) | 33.5 (25.3, 41.7) | 0.036 |
1-year OS rate, % | 81.4 | 82.9 | 79.5 | |
3-year OS rate, % | 52.8 | 57.5 | 47.0 | |
5-year OS rate, % | 39.8 | 44.7 | 33.4 | |
Median RFS (95% CI), months | 18.2 (14.2, 22.2) | 22.2 (16.2, 28.2) | 13.7 (9.9, 17.4) | 0.009 |
1-year RFS rate, % | 60.4 | 64.7 | 55.0 | |
3-year RFS rate, % | 35.2 | 40.0 | 29.4 | |
5-year RFS rate, % | 26.2 | 31.0 | 20.3 |
CI, confidence interval; OS, overall survival; RFS, recurrence-free survival.
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