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
. 2025 Jul 29;9(8):e0772.
doi: 10.1097/HC9.0000000000000772. eCollection 2025 Aug 1.

Outcome of hepatic resection for HCC in ideal and non-ideal candidates

Lorenzo Lani  1   2 , Laura Bucci  1   2 , Valentina Santi  1 , Benedetta Stefanini  1   2 , Bernardo Stefanini  2   3 , Angelo Sangiovanni  4 , Sara Grasselli  5 , Giorgia Ghittoni  6 , Carlo Saitta  7 , Filomena Morisco  8 , Giuseppe Cabibbo  9 , Fabio Marra  10 , Gianpaolo Vidili  11 , Maurizia Rossana Brunetto  12 , Francesco Giuseppe Foschi  13 , Mariella Di Marco  14 , Gianluca Svegliati-Baroni  15 , Filippo Pelizzaro  16 , Francesco Azzaroli  17 , Francesca Romana Ponziani  18 , Andrea Martini  19 , David Sacerdoti  20 , Andrea Mega  21 , Sara Boninsegna  22 , Edoardo G Giannini  23   24 , Donatella Magalotti  25 , Rodolfo Sacco  26 , Gerardo Nardone  27 , Paolo Caraceni  1   2 , Alessandro Vitale  16 , Franco Trevisani  28 ; and the Italian Liver Cancer group
Collaborators, Affiliations

Outcome of hepatic resection for HCC in ideal and non-ideal candidates

Lorenzo Lani et al. Hepatol Commun. .

Abstract

Background: The Barcelona Clinic Liver Cancer staging system considers, among patients with HCC, "ideal candidates" (ICs) for hepatic resection (HR) those with a single lesion, normal bilirubin, and without clinically significant portal hypertension (CSPH). We compared the outcome of HR between ICs and non-ICs.

Methods: Retrospective analysis was conducted on Child-Pugh A patients. CSPH was defined by the presence of gastroesophageal varices and/or platelet count <100,000/mm3. Hyperbilirubinemia was accepted up to 2 mg/dL. The selected 1057 patients were distributed in 3 calendar periods (2000-2022).

Results: In all calendar periods, non-ICs were more prevalent than ICs. Among non-ICs, the proportion of patients with isolated CSPH did not change over time (from 22.6% to 30.3%; p=0.359), while patients with multinodular HCC (mHCC) increased (from 35.5% to 50.2%; p=0.042). Patients with hyperbilirubinemia decreased (from 20.4% to 10.1%; p=0.036), likewise those with hyperbilirubinemia+CSPH (from 21.5% to 9.4%; p=0.005). Over a median follow-up of 41.0 months, median overall survival was higher in ICs compared to non-ICs (104.9 vs. 75.3 months; p<0.001). However, compared to ICs, median overall survival did not differ in patients with isolated CSPH (93.1 mo; p=0.432) or isolated hyperbilirubinemia (86.0 mo; p=0.356), while it was lower in those with hyperbilirubinemia+CSPH (60.0 mo; p<0.001) or mHCC (61.9 mo; p<0.001). Compared to ICs, only hyperbilirubinemia+CSPH patients showed a higher perioperative mortality.

Conclusions: In real-world practice, among resected patients, the proportion of non-ICs has remained constantly higher than that of non-ICs since 2000. HR can be offered to Child-Pugh A patients with CSPH or modest hyperbilirubinemia without compromising its outcome. For patients with 2 of these features or mHCC, which generate a poorer prognosis, studies comparing HR versus non-surgical therapies are warranted.

Keywords: HCC; clinically significant portal hypertension; hepatic resection; hyperbilirubinemia; liver resection.

PubMed Disclaimer

Conflict of interest statement

Franco Trevisani—AbbVie, AstraZeneca, EISAI, Gilead, MSD, and Roche: advisory board and research funds. Edoardo Giovanni Giannini—AbbVie, EISAI, Gilead, and Roche: speaking and teaching; and Ipsen: advisory board. Filomena Morisco—Astra Zeneca and Ipsen: advisory board; and Gilead and Roche: research funds. Giuseppe Cabibbo participated in advisory boards and received speaker fees from Bayer, Eisai, Ipsen, AstraZeneca, MSD, Roche, and Gilead. Fabio Marra—Roche, EISAI/MSD, AstraZeneca, and Ipsen: travel grants and consultant; and Gore: consultant. Lorenzo Lani—Alfa Sigma and Astra Zeneca: travel expenses.

Figures

FIGURE 1
FIGURE 1
Flowchart describing the construction of the final analytic dataset of Child–Pugh A patients with HCC treated with hepatic resection or other treatments. Abbreviation: ECOG-PS, Eastern Cooperative Oncology Group-Performance Status.
FIGURE 2
FIGURE 2
Proportion of ideal and non-ideal candidates across the study periods (A); overtime distribution of non-ideal candidates according to the cause preventing the inclusion into the ideal group (B). Abbreviations: ICs, ideal candidates; NICs, non-ideal candidates; CSPH, clinically significant portal hypertension.
FIGURE 3
FIGURE 3
Overall survival in the whole population of resected patients (ideal candidates vs. non-ideal candidates) (A); in patients with isolated hyperbilirubinemia versus ideal candidates (B); in patients with CSPH versus ideal candidates (C); in patients with hyperbilirubinemia+CSPH versus ideal candidates (D); in patients with multinodular HCC versus ideal candidates (E). Abbreviations: CSPH, clinically significant portal hypertension; ICs, ideal candidates; NICs, non-ideal candidates.
See this image and copyright information in PMC

References

    1. Vitale A, Cabibbo G, Iavarone M, Viganò L, Pinato DJ, Ponziani FR, et al. Personalised management of patients with hepatocellular carcinoma: A multiparametric therapeutic hierarchy concept. Lancet Oncol. 2023;24:e312–e322. - PubMed
    1. Sangro B, Argemi J, Ronot M, Paradis V, Meyer T, Mazzaferro V, et al. EASL Clinical Practice Guidelines on the management of hepatocellular carcinoma. J Hepatol. 2025;82:315–374. - PubMed
    1. Reig M, Forner A, Rimola J, Ferrer-Fàbrega J, Burrel M, Garcia-Criado Á, et al. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J Hepatol. 2022;76:681–693. - PMC - PubMed
    1. Singal AG, Llovet JM, Yarchoan M, Mehta N, Heimbach JK, Dawson LA, et al. AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology. 2023;78:1922–1965. - PMC - PubMed
    1. Llovet JM, Fuster J, Bruix J. Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: Resection versus transplantation. Hepatology. 1999;30:1434–1440. - PubMed

MeSH terms