The role of resection in hepatocellular carcinoma BCLC stage B: A multi-institutional patient-level meta-analysis and systematic review.

Carcinoma, Hepatocellular / surgery Liver Neoplasms / surgery Humans Hepatectomy Neoplasm Staging Liver Transplantation Patient Selection Survival Rate

BCLC-B HCC Liver resection Liver transplantation

Journal

Langenbeck's archives of surgery

ISSN: 1435-2451

Titre abrégé: Langenbecks Arch Surg

Pays: Germany

ID NLM: 9808285

Informations de publication

Date de publication:
13 Sep 2024

Historique:

received: 18 03 2024

accepted: 01 09 2024

medline: 13 9 2024

pubmed: 13 9 2024

entrez: 13 9 2024

Statut: epublish

Résumé

The Barcelona Clinic Liver Cancer (BCLC) staging schema is widely used for hepatocellular carcinoma (HCC) treatment. In the updated recommendations, HCC BCLC stage B can become candidates for transplantation. In contrast, hepatectomy is currently not recommended. This systematic review includes a multi-institutional meta-analysis of patient-level data. Survival, postoperative mortality, morbidity and patient selection criteria for liver resection and transplantation in BCLC stage B are explored. All clinical studies reporting HCC patients with BCLC stage B undergoing liver resection or transplantation were included. A total of 31 studies with 3163 patients were included. Patient level data was available for 580 patients from 9 studies (423 after resection and 157 after transplantation). The overall survival following resection was 50 months and recurrence-free survival was 15 months. Overall survival after transplantation was not reached and recurrence-free survival was 45 months. The major complication rate after resection was 0.11 (95%-CI, 0.0-0.17) with the 90-day mortality rate of 0.03 (95%-CI, 0.03-0.08). Child-Pugh A (93%), minor resection (60%), alpha protein level less than 400 (64%) were common in resected patients. Resected patients were mostly outside the Milan criteria (99%) with mean tumour number of 2.9. Studies reporting liver transplantation in BCLC stage B were scarce. Liver resection can be performed safely in selected patients with HCC BCLC stage B, particularly if patients present with preserved liver function. No conclusion can done on liver transplantation due to scarcity of reported studies.

Identifiants

DOI: 10.1007/s00423-024-03466-x PMID: 39269544

pubmed: 39269544

doi: 10.1007/s00423-024-03466-x

pii: 10.1007/s00423-024-03466-x

doi:

Types de publication

Journal Article Systematic Review Meta-Analysis

Langues

eng

Sous-ensembles de citation

Pagination

277

Informations de copyright

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