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. 2017 Aug 22;15(1):156.
doi: 10.1186/s12957-017-1229-x.

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

Toshiya Kamiyama  1 , Tatsuya Orimo  2 , Kenji Wakayama  2 , Shingo Shimada  2 , Akihisa Nagatsu  2 , Hideki Yokoo  2 , Hirofumi Kamachi  2 , Kenichiro Yamashita  3 , Tsuyoshi Shimamura  4 , Akinobu Taketomi  2
Affiliations

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

Toshiya Kamiyama et al. World J Surg Oncol. .

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 < 105), and AP3 (AFP × PIVKA-II ≥ 105).

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 × 105 show acceptable 5-year OS rates and could be treated by hepatectomy.

Keywords: BCLC staging.; Hepatectomy; Hepatocellar carcinoma.

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Conflict of interest statement

Ethics approval and consent to participate

All analyses in our present study were performed in accordance with the ethical guidelines of Hokkaido University Hospital. This study was approved by the Institutional Review Board of Hokkaido University. The study was performed according to the Helsinki Declaration guidelines.

Consent for publication

We obtained consent for publication from the patients.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Overall survival curves according to tumor number and AP-factor. a The 5-year overall survival rates of B1, B23, and B4over were 63.6, 52.3, and 29.0%, respectively. There was a significant difference between each of these groups (p < 0.01), except for B1 and B23. The 5-year disease-free survival rates of B1 and B23 were 30.1 and 15.5%, respectively (p < 0.01). b The 5-year overall survival rates of AP1, AP2, and AP3 were 67.6, 65.2, and 39.1%, respectively. There was a significant difference between AP1 and AP3 (p < 0.01) and between AP2 and AP3 (p < 0.01). The 5-year disease-free survival rates of AP1, AP2, and AP3 were 23.8, 28.6, and 15.2%, respectively. There was a significant difference between AP1 and AP3 (p < 0.01) and between AP2 and AP3 (p < 0.01)
Fig. 2
Fig. 2
Overall survival curves for groups A, B and C. Overall survival curves for groups A-C with 5-year patient survival rates of 69.5, 43.7, and 21.3%, respectively. There was a significant difference between each of these groups (p < 0.01). The 5-year disease-free survival rates of group A and group B were 30.5 and 14.3%, respectively (p < 0.01)
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