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Survival outcomes of hepatectomy for stage B Hepatocellular carcinoma in the BCLC classification

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Title: Survival outcomes of hepatectomy for stage B Hepatocellular carcinoma in the BCLC classification
Authors: Kamiyama, Toshiya Browse this author →KAKEN DB
Orimo, Tatsuya Browse this author
Wakayama, Kenji Browse this author
Shimada, Shingo Browse this author
Nagatsu, Akihisa Browse this author
Yokoo, Hideki Browse this author →KAKEN DB
Kamachi, Hirofumi Browse this author →KAKEN DB
Yamashita, Kenichiro Browse this author →KAKEN DB
Shimamura, Tsuyoshi Browse this author →KAKEN DB
Taketomi, Akinobu Browse this author →KAKEN DB
Keywords: Hepatocellar carcinoma
Hepatectomy
BCLC staging
Issue Date: 22-Aug-2017
Publisher: BioMed Central
Journal Title: World journal of surgical oncology
Volume: 15
Start Page: 156
Publisher DOI: 10.1186/s12957-017-1229-x
Abstract: Background: Because hepatectomy is not recommended in patients with stage B hepatocellular carcinoma (HCC) of the Barcelona Clinic Liver Cancer (BCLC) staging, we evaluated the survival outcomes of hepatectomy for stage B in the BCLC system. Methods: Data were collected from 297 consecutive adult stage B patients who underwent curative hepatectomy for HCC between 1996 and 2014 in Hokkaido University Hospital. Overall survival (OS), disease-free survival (DFS), and risk factors were analyzed using the Kaplan-Meier method. Independent prognostic factors were evaluated using a Cox proportional hazards regression model. AP-factor (alpha-fetoprotein [AFP] × protein induced by vitamin K absence or antagonism factor II [PIVKA-II]) was categorized according to the serum concentrations of AFP and PIVKA-II: AP1 (AFP < 200 ng/ml and PIVKA-II < 100 mAU/ml), AP2 (AFP × PIVKA-II < 10^5), and AP3 (AFP × PIVKA-II ≥ 10^5). Results: There were 130 deaths among our 297 stage B patients (43.8%). The causes of death in these cases were HCC recurrence (n = 106; 81.5%), liver failure (n = 7; 5.4%), and other causes (n = 17; 16.1%). The operative mortality rate was 0.34% (1/297). The 5-year OS and DFS rates for the stage B cases were 54.3 and 21.9%, respectively. By multivariate analysis, tumor number and AP-factor were risk factors for both survival and recurrence that were tumor related and could be evaluated preoperatively. The study patients with stage B HCC were classified into three groups by tumor number (B1, 1; B23, 2 or 3; B4over: ≥4) and into three groups stratified by AP-factor (AP1, AP2, and AP3). The 5-year OS rates of B1, B23, and B4over were 63.6, 52.3, and 29.0%. The 5-year OS rates of AP1, AP2, and AP3 were 67.6, 65.2, and 39.1%. Stratified by the 5-year OS rate, stage B HCC patients were classified into three subgroups (A-C).The 5-year OS rates of groups A (B1 or B23 and AP-1 or AP-2), B (B1 or B23 and AP-3, or B4over and AP-1 or AP-2), and C (B4over and AP-3) were 69.5, 43.7, and 21.3%. Conclusion: Stage B HCC patients with a tumor number ≤ 3 and/or AP-factor < 1 × 10^5 show acceptable 5-year OS rates and could be treated by hepatectomy.
Rights: http://creativecommons.org/licenses/by/4.0/
Type: article
URI: http://hdl.handle.net/2115/67381
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 神山 俊哉

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