Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr 29;14(2):768-779.
doi: 10.21037/jgo-23-69. Epub 2023 Apr 11.

Evaluation of the up-to-7 criterion for determining the treatment of hepatocellular carcinoma in Barcelona Clinic Liver Cancer stage B: a single-center retrospective cohort study

Xiang Nong #  1 , Yumei Zhang #  2 , Jinlong Xie  1 , Jingchang Liang  1 , Aize Xie #  3 , Zhiming Zhang #  1
Affiliations

Evaluation of the up-to-7 criterion for determining the treatment of hepatocellular carcinoma in Barcelona Clinic Liver Cancer stage B: a single-center retrospective cohort study

Xiang Nong et al. J Gastrointest Oncol. .

Abstract

Background: At present, there are still disputes on the treatment of surgery for patients with stage B hepatocellular carcinoma (HCC). This study sought to investigate whether the up-to-7 criterion could be used to decide the treatment for HCC in Barcelona Clinic Liver Cancer stage B (BCLC-B).

Methods: We analyzed 340 patients with HCC in BCLC-B who treated with hepatectomy or transcatheter arterial chemoembolization (TACE). Of the 285 HCC patients who underwent hepatectomy, 108 met the up-to-7 criterion and 177 exceeded it. All 55 patients in the TACE group met the up-to-7 criterion. We obtained the tumor status of the patients through inpatient medical records, outpatient medical records, and telephone follow-up of the hospital. We compared overall survival (OS) and progression-free survival (PFS) were compared between patients who met the up-to-7 criterion and who underwent either hepatectomy or TACE. OS and recurrence time were also compared between the patients who were treated with hepatectomy and who either met or exceeded the up-to-7 criterion. Across BCLC-B patients, we compared the OS of patients after surgical treatment between subgroups stratified by tumor number and diameter.

Results: Patients who met the up-to-7 criterion had significantly higher OS rates after hepatectomy than TACE (P<0.001). However, the 2 groups did not differ in terms of PFS (P=0.758). Among the patients treated by hepatectomy, the OS rates were significantly higher in patients who met the up-to-7 criterion than in those who exceeded it (P=0.001). The recurrence rates did not differ between patients who met or exceeded the criterion (P=0.662). OS was significantly higher in patients with ≤3 tumors than those with >3 tumors (P=0.001). When we stratified patients with ≤3 tumors based in whether they met or exceeded the up-to-8 to up-to-15 criterion, OS was significantly better among those who met the criterion in all cases.

Conclusions: Hepatectomy appears to be associated with better survival than TACE in patients with BCLC-B HCC who meet the up-to-7 criterion, but this criterion is not a strict indication for deciding whether to treat patients with BCLC-B surgically. Tumor number strongly affects the prognosis of BCLC-B patients after hepatectomy.

Keywords: Hepatocellular carcinoma (HCC); hepatectomy; transcatheter arterial chemoembolization (TACE); up-to-7 criterion.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jgo.amegroups.com/article/view/10.21037/jgo-23-69/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Comparison of the overall survival rates between patients who met the up-to-7 criterion who were treated by hepatectomy or TACE. TACE, transcatheter arterial chemoembolization.
Figure 2
Figure 2
Comparison of progression-free survival rates between the patients who met the up-to-7 criterion who were treated by hepatectomy or TACE. TACE, transcatheter arterial chemoembolization.
Figure 3
Figure 3
Comparison of the overall survival rates between patients who underwent hepatectomy and who either met or exceeded the up-to-7 criterion.
Figure 4
Figure 4
Comparison of the recurrence rates between patients who underwent hepatectomy and who either met or exceeded the up-to-7 criterion.
Figure 5
Figure 5
Comparison of the overall survival in patients who underwent hepatectomy, stratified by number of tumors.
Figure 6
Figure 6
Comparison of the overall survival between patients with ≤3 tumors who underwent hepatectomy and who either met or exceeded the indicated “up-to” criterion.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021;71:209-49. 10.3322/caac.21660 - DOI - PubMed
    1. Reig M, Forner A, Rimola J, et al. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J Hepatol 2022;76:681-93. 10.1016/j.jhep.2021.11.018 - DOI - PMC - PubMed
    1. Gao R. Hypoxia features as potential indicators in prognosis, immunotherapy and drug screening in hepatocellular carcinoma patients. Transl Cancer Res 2022;11:3932-4. 10.21037/tcr-22-2173 - DOI - PMC - PubMed
    1. Feng H, Yang C, Xu F, et al. Therapeutic efficacy of microwave coagulation versus liver resection for hepatocellular carcinoma within the Milan criteria: A propensity score matching analysis. Eur J Surg Oncol 2022;48:418-24. 10.1016/j.ejso.2021.08.035 - DOI - PubMed
    1. Shin SW, Ahn KS, Kim SW, et al. Liver Resection Versus Local Ablation Therapies for Hepatocellular Carcinoma Within the Milan Criteria: A Systematic Review and Meta-analysis. Ann Surg 2021;273:656-66. 10.1097/SLA.0000000000004350 - DOI - PubMed