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

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

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 examined. Patients with a single large tumor were classified as BCLC stage A1 and were independently assessed.

Results

Among 814 patients, 68 (8.4%) were BCLC-0, 310 (38.1%) were BCLC-A, 279 (34.3%) were BCLC-A1, and 157 (19.3%) were BCLC-B. Five-year OS among patients with BCLC stage 0, A, A1, and B HCC was 86.2%, 69.0%, 56.9%, and 49.9%, respectively (p < 0.001). Among patients with very early- and early-stage HCC (BCLC 0, A, and A1), patients with BCLC stage A1 had the worst OS (p = 0.0016). No difference in survival was noted among patients undergoing surgery for BCLC stage A1 and B HCC (5-year OS: 56.9% vs. 49.9%; p = 0.259) even after adjusting for competing factors (hazard ratio 0.83, 95% confidence interval 0.54–1.28; p = 0.40).

Conclusion

Prognosis following liver resection among patients with BCLC-A1 HCC was similar to patients presenting with BCLC-B tumors. Surgery provided acceptable long-term outcomes among select patients with BCLC-B HCC. Designation into BCLC stage B should not be considered an a priori contraindication to surgery.

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Authors and Affiliations

  1. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Diamantis I. Tsilimigras MD, Fabio Bagante MD, Kota Sahara MD, Dimitrios Moris MD, PhD, J. Madison Hyer MS, Lu Wu MD, Anghela Z. Paredes MD, MS & Timothy M. Pawlik MD, MPH, PhD, FACS

  2. Department of Surgery, University of Verona, Verona, Italy

    Fabio Bagante MD & Alfredo Guglielmi MD

  3. Department of Surgery, Ospedale San Raffaele, Milan, Italy

    Francesca Ratti MD & Luca Aldrighetti MD

  4. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal

    Hugo P. Marques MD

  5. Department of Hepatobiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France

    Olivier Soubrane MD

  6. Department of Surgery, Westmead Hospital, Sydney, NSW, Australia

    Vincent Lam MD

  7. Department of Surgery, Stanford University, Stanford, CA, USA

    George A. Poultsides MD

  8. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania

    Irinel Popescu MD & Sorin Alexandrescu MD

  9. Department of Surgery, University of Ottawa, Ottawa, ON, Canada

    Guillaume Martel MD & Aklile Workneh MD

  10. Department of Surgery, The University of Sydney, School of Medicine, Sydney, NSW, Australia

    Tom Hugh MD

  11. Yokohama City University School of Medicine, Yokohama, Japan

    Itaru Endo MD, PhD

Authors
  1. Diamantis I. Tsilimigras MD
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  2. Fabio Bagante MD
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  3. Kota Sahara MD
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  4. Dimitrios Moris MD, PhD
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  6. Lu Wu MD
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  7. Francesca Ratti MD
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  8. Hugo P. Marques MD
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  9. Olivier Soubrane MD
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  10. Anghela Z. Paredes MD, MS
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  11. Vincent Lam MD
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  12. George A. Poultsides MD
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  14. Sorin Alexandrescu MD
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  16. Aklile Workneh MD
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  17. Alfredo Guglielmi MD
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  18. Tom Hugh MD
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  21. Timothy M. Pawlik MD, MPH, PhD, FACS
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Correspondence to Timothy M. Pawlik MD, MPH, PhD, FACS.

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Tsilimigras, D.I., Bagante, F., Sahara, K. et al. Prognosis After Resection of Barcelona Clinic Liver Cancer (BCLC) Stage 0, A, and B Hepatocellular Carcinoma: A Comprehensive Assessment of the Current BCLC Classification. Ann Surg Oncol 26, 3693–3700 (2019). https://doi.org/10.1245/s10434-019-07580-9

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  • DOI: https://doi.org/10.1245/s10434-019-07580-9

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