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Recurrence Patterns and Outcomes after Resection of Hepatocellular Carcinoma within and beyond the Barcelona Clinic Liver Cancer Criteria.

Publication ,  Journal Article
Tsilimigras, DI; Bagante, F; Moris, D; Hyer, JM; Sahara, K; Paredes, AZ; Mehta, R; Ratti, F; Marques, HP; Soubrane, O; Lam, V; Poultsides, GA ...
Published in: Annals of surgical oncology
July 2020

Several investigators have advocated for extending the Barcelona Clinic Liver Cancer (BCLC) resection criteria to select patients with BCLC-B and even BCLC-C hepatocellular carcinoma (HCC). The objective of the current study was to define the outcomes and recurrence patterns after resection within and beyond the current resection criteria.Patients who underwent resection for HCC within (i.e., BCLC 0/A) and beyond (i.e. BCLC B/C) the current resection criteria between 2005 and 2017 were identified from an international multi-institutional database. Overall survival (OS), disease-free survival (DFS), as well as patterns of recurrence of patients undergoing HCC resection within and beyond the BCLC guidelines were examined.Among 756 patients, 602 (79.6%) patients were BCLC 0/A and 154 (20.4%) were BCLC B/C. Recurrences were mostly intrahepatic (within BCLC: 74.3% versus beyond BCLC: 70.8%, p = 0.80), with BCLC B/C patients more often having multiple tumors at relapse (69.6% versus 49.4%, p = 0.001) and higher rates of early (< 2 years) recurrence (88.0% versus 75.5%, p = 0.011). During the first postoperative year, annual recurrence was 38.3% and 21.3% among BCLC B/C and BCLC 0/A patients, respectively; 5-year OS among BCLC 0/A and BCLC B/C patients was 76.9% versus 51.6% (p = 0.003). On multivariable analysis, only a-fetoprotein (AFP) > 400 ng/mL (HR = 1.84, 95% CI 1.07-3.15) and R1 resection (HR = 2.36, 95% CI 1.32-4.23) were associated with higher risk of recurrence among BCLC B/C patients.Surgery can provide acceptable outcomes among select patients with BCLC B/C HCC. The data emphasize the need to further refine the BCLC treatment algorithm as well as highlight the need for surveillance protocols with a particular focus on the liver, especially for patients undergoing resection outside the BCLC criteria.

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Published In

Annals of surgical oncology

DOI

EISSN

1534-4681

ISSN

1068-9265

Publication Date

July 2020

Volume

27

Issue

7

Start / End Page

2321 / 2331

Related Subject Headings

  • Treatment Outcome
  • Survival Rate
  • Retrospective Studies
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Neoplasm Recurrence, Local
  • Liver Neoplasms
  • Humans
  • Hepatectomy
  • Carcinoma, Hepatocellular
 

Citation

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Tsilimigras, D. I., Bagante, F., Moris, D., Hyer, J. M., Sahara, K., Paredes, A. Z., … Pawlik, T. M. (2020). Recurrence Patterns and Outcomes after Resection of Hepatocellular Carcinoma within and beyond the Barcelona Clinic Liver Cancer Criteria. Annals of Surgical Oncology, 27(7), 2321–2331. https://doi.org/10.1245/s10434-020-08452-3
Tsilimigras, Diamantis I., Fabio Bagante, Dimitrios Moris, J Madison Hyer, Kota Sahara, Anghela Z. Paredes, Rittal Mehta, et al. “Recurrence Patterns and Outcomes after Resection of Hepatocellular Carcinoma within and beyond the Barcelona Clinic Liver Cancer Criteria.Annals of Surgical Oncology 27, no. 7 (July 2020): 2321–31. https://doi.org/10.1245/s10434-020-08452-3.
Tsilimigras DI, Bagante F, Moris D, Hyer JM, Sahara K, Paredes AZ, et al. Recurrence Patterns and Outcomes after Resection of Hepatocellular Carcinoma within and beyond the Barcelona Clinic Liver Cancer Criteria. Annals of surgical oncology. 2020 Jul;27(7):2321–31.
Tsilimigras, Diamantis I., et al. “Recurrence Patterns and Outcomes after Resection of Hepatocellular Carcinoma within and beyond the Barcelona Clinic Liver Cancer Criteria.Annals of Surgical Oncology, vol. 27, no. 7, July 2020, pp. 2321–31. Epmc, doi:10.1245/s10434-020-08452-3.
Tsilimigras DI, Bagante F, Moris D, Hyer JM, Sahara K, Paredes AZ, Mehta R, Ratti F, Marques HP, Soubrane O, Lam V, Poultsides GA, Popescu I, Alexandrescu S, Martel G, Workneh A, Guglielmi A, Hugh T, Aldrighetti L, Endo I, Pawlik TM. Recurrence Patterns and Outcomes after Resection of Hepatocellular Carcinoma within and beyond the Barcelona Clinic Liver Cancer Criteria. Annals of surgical oncology. 2020 Jul;27(7):2321–2331.
Journal cover image

Published In

Annals of surgical oncology

DOI

EISSN

1534-4681

ISSN

1068-9265

Publication Date

July 2020

Volume

27

Issue

7

Start / End Page

2321 / 2331

Related Subject Headings

  • Treatment Outcome
  • Survival Rate
  • Retrospective Studies
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Neoplasm Recurrence, Local
  • Liver Neoplasms
  • Humans
  • Hepatectomy
  • Carcinoma, Hepatocellular