Liver resection is the most effective treatment for hepatocellular carcinoma （HCC）. The Barcelona Clinic Liver Cancer （BCLC） staging system is commonly accepted as a guideline for HCC treatment, but it only recomm...Liver resection is the most effective treatment for hepatocellular carcinoma （HCC）. The Barcelona Clinic Liver Cancer （BCLC） staging system is commonly accepted as a guideline for HCC treatment, but it only recommends liver resection for the patients with HCC at stage 0 to A1. The surgical indications of the BCLC staging system need to be re-evaluated. 120 HCC patients undergoing curative liver resection were retrospectively stratified to the BCLC staging system, and the survival of the patients at stages A, B and C was analyzed. The justification of the BCLC staging system was re-evaluated. Fifty-two patients were classified at stage A, 51 at stage B and 17 at stage C respectively. The hospital mortality of this cohort was zero and the morbidity was 24.1%. The 1-, 2-, 3-year overall survival rate of this cohort was 81.6%, 68.3%, and 57.5% respectively. There was no signifi-cant difference in the survival rate between the patients at stage A and B （P〉0.05）. If the treatment guidelines of BCLC staging system were followed, the majority of the patients at stages A and B （77.7%, 80/103） would not have been treated surgically. Our data suggest that the surgical indications of the BCLC staging system are not justified for HCC treatment. More studies may be needed as for how to further broaden the surgical indications of the BCLC staging system in the future.展开更多
BACKGROUND： The Barcelona Clinic Liver Cancer（BCLC）staging system for hepatocellular carcinoma（HCC） recommends transarterial chemoembolization（TACE） as the first line therapy for stage B patients and sorafenib ...BACKGROUND： The Barcelona Clinic Liver Cancer（BCLC）staging system for hepatocellular carcinoma（HCC） recommends transarterial chemoembolization（TACE） as the first line therapy for stage B patients and sorafenib treatment for stage C patients.However, stage C patients exhibit variations in terms of tumor burden, liver function, and extrahepatic metastasis, which could potentially affect disease outcome. Here, we assessed whether the Cancer of the Liver Italian Program（CLIP） scores can help identify stage C patients likely to benefit from TACE.METHODS： Out of 295 BCLC stage C HCC patients enrolled between January 2009 and December 2011, those with platelet counts 〉30×10~9 cells/L, total bilirubin 〈51 μmo L/L, and an unobstructed main portal vein were scheduled for TACE（n=195）. The remaining patients received best supportive care（BSC, n=100）.All the patients were followed up for symptoms, performance status, and Child-Pugh classification scores every 4 weeks until death or December 2013. The prognosis of each group was evaluated by using the log-rank test and Cox-Mantel test.RESULTS： The median overall survival（OS） was 6 months [95% confidence interval（CI）： 4.64-7.36]. The OS was 9 months for the TACE group and 4 months for the BSC group. The TACE group had a longer OS than the BSC subgroup for CLIP scores 0-2 [13 months（95% CI： 8.55-17.45） vs 4 months（95% CI：0.00-10.96）, P=0.001]. No significant differences were found between the TACE and BSC groups for CLIP scores 3-5. The CLIP score and treatment methods were found to be independent prognostic factors.CONCLUSIONS： BCLC stage C HCC patients exhibit definite disease heterogeneity and can be reclassified by using the CLIP scoring system. Moreover, patients with CLIP scores 0-2 are likely to benefit from TACE. However, additional studies with long-term follow-up will be required to validate these findings.展开更多
Background:According to the 2022 update of the BCLC strategy,laparoscopic liver resection(LLR)is considered feasible for BCLC stage 0-A hepatocellular carcinoma(HCC)patients with clinically significant portal hyperten...Background:According to the 2022 update of the BCLC strategy,laparoscopic liver resection(LLR)is considered feasible for BCLC stage 0-A hepatocellular carcinoma(HCC)patients with clinically significant portal hypertension(CSPH).However,there is still no research to explore the outcomes of laparoscopic versus open liver resection(OLR)in the specific patients with BCLC stage 0-A HCC and CSPH.Methods:Patients diagnosed with BCLC stage 0-A HCC and CSPH who underwent liver resection at West China Hospital of Sichuan University from February 2018 to December 2022 were analyzed.Demographic characteristics,pathological findings and postoperative outcomes were compared using propensity score matching(PSM).Long-term outcomes after surgery were analyzed using Kaplan-Meier analysis both before and after PSM.Results:A total of 409 patients,including 261 LLRs and 148 OLRs,were enrolled in this study.There were imbalances between the groups in baseline information.After 1:1 PSM,118 patients were included in each group with comparable baseline characteristics.Patients in the LLR group had significantly less intraoperative blood loss compared to those in the OLR group(median 223 vs.318 mL,P<0.001),and fewer postoperative complications(33.9%vs.57.6%,P<0.001),including lower rates of postoperative liver decompensation(16.9%vs.28.0%,P=0.043),postoperative ascites(18.6%vs.31.4%,P=0.024)and pulmonary infections(12.7%vs.29.7%,P=0.001).The long-term follow-up showed that overall survival(P=0.154)and recurrence-free survival(P=0.376)were comparable between the two groups.In subgroup analysis,patients with PLT≤75×10^(9)/L suffered more postoperative liver decompensation(PLD)and ascites than patiens with PLT>75×10^(9)/L.Conclusions:Compared with OLR,LLR had less intraoperative blood loss,fewer postoperative complications and comparable oncological outcomes for patients with BCLC stage 0/A HCC and CSPH.展开更多
Hepatocellular carcinoma(HCC)is the third-leading cause of cancer-related mortality worldwide(1).While upfront surgical resection has been established as an effective curative treatment for early-stage disease,up to 5...Hepatocellular carcinoma(HCC)is the third-leading cause of cancer-related mortality worldwide(1).While upfront surgical resection has been established as an effective curative treatment for early-stage disease,up to 53.6%of patients present with moderate-to-advanced stage disease(2).Traditional recommendations as per the latest Barcelona Clinic Liver Cancer(BCLC)2022 update have advised for palliative transarterial chemoembolization(TACE)or systemic treatment(3),leaving this patient group with only modest response rates of 5%to 40%(4).However,with oncological advancements in recent years,conversion therapy has emerged as an effective strategy to change the therapeutic trajectory of patients with BCLC stage B and BCLC stage C HCC,showing significantly improved long-term outcomes compared to systemic therapy alone(5).展开更多
Background:Barcelona clinic liver cancer(BCLC)stage B(intermediate stage)hepatocellular carcinoma(HCC)is highly heterogeneous;thus,identifying the most effective treatment for individual patients represents a signific...Background:Barcelona clinic liver cancer(BCLC)stage B(intermediate stage)hepatocellular carcinoma(HCC)is highly heterogeneous;thus,identifying the most effective treatment for individual patients represents a significant clinical challenge.However,transarterial chemoembolization(TACE)is the only recommended treatment option.Therefore,we aimed to investigate the patient characteristics and outcomes of living donor liver transplantation(LDLT)for BCLC stage B HCC.Methods:A total of 516 patients with BCLC stage B HCC who underwent LDLT(n=104)or did not undergo LDLT(non-LDLT;n=412)between 2004 to 2018 were analyzed by propensity score matching(PSM;1:4)analysis.Factors influencing overall survival(OS)and recurrence were analyzed using Cox’s proportional hazards models.Results:Patients treated with LDLT achieved better OS than the non-LDLT group,including liver-and non-liver related survival(all P<0.001).Multivariate Cox regression analysis showed age>60 years(P=0.006),a neutrophil-lymphocyte ratio(NLR)>4(P=0.016)and>3 locoregional therapies(LRT)before LDLT(P<0.001)were independent risk factors for HCC recurrence.In addition,age>60 years(P<0.001)and>3 LRT before LDLT(P=0.001)were independent risk factors for OS.Using a combination of age,NLR,and LRT before liver transplantation(LT),the patients can be divided into low-risk(none of risk),intermediate-risk(one of risk),and high risk(more than two of risk)groups.There were significant differences in the cumulative HCC recurrence(P<0.001)and mortality(P<0.001)rates among the three groups.Conclusions:LDLT may represent a valuable therapeutic option for selected patients with BCLC stage B HCC.展开更多
At the beginning of the 21st century,in a global attempt to guide and organize the treatment of hepatocellular carcinoma(HCC),which had reached 7th place as the most frequent cancer due to the historical coincidence o...At the beginning of the 21st century,in a global attempt to guide and organize the treatment of hepatocellular carcinoma(HCC),which had reached 7th place as the most frequent cancer due to the historical coincidence of three confluent pandemics worldwide(alcoholism,obesity and viral hepatitis),several HCC classification proposals arose,among them,the one elaborated by Llovet et al.,members of the Liver Unit of Barcelona Clinic Hospital,who published the first version of the Barcelona Clinic Liver Cancer(BCLC)in 1999.展开更多
For intermediate-stage hepatocellular carcinoma(HCC)in the Barcelona Clinic Liver Cancer(BCLC),transarterial chemoembolization(TACE)is advised as the initial treatment.The term“BCLC intermediate-stage HCC”(BCLC stag...For intermediate-stage hepatocellular carcinoma(HCC)in the Barcelona Clinic Liver Cancer(BCLC),transarterial chemoembolization(TACE)is advised as the initial treatment.The term“BCLC intermediate-stage HCC”(BCLC stage B)refers to a group of patients with varying liver functions and single big nodules or many nodules that do not have distant metastases or vascular invasion(1).In general,tumors beyond the Milan criteria(single tumor>5 cm or≥4 nodules)are classified as BCLC intermediate-stage HCC.Consequently,not every patient with intermediate-stage HCC in BCLC is a good candidate for TACE alone;this is especially true for patients who have a substantial tumor bulk,multinodular dissemination,or decreased liver function.TACE refractory cases cannot get full TACE treatment.展开更多
基金supported by grants from the National Natural Science Foundation of China (No. 30772126)the New Century Excellent Talent Foundation of China Ministry of Education (No. NCET-04-0701) to Dr. Zhiyong HUANG+1 种基金by grants from the Chinese Ministry of Public Health for Key Clinical Projects (No. 353, 2007)the Health Department, the Science & Technology Department of Hubei Province for the Clinical Medicine Research Centre of Hepatic Surgery (2007) to Dr. Xiaoping CHEN
文摘Liver resection is the most effective treatment for hepatocellular carcinoma （HCC）. The Barcelona Clinic Liver Cancer （BCLC） staging system is commonly accepted as a guideline for HCC treatment, but it only recommends liver resection for the patients with HCC at stage 0 to A1. The surgical indications of the BCLC staging system need to be re-evaluated. 120 HCC patients undergoing curative liver resection were retrospectively stratified to the BCLC staging system, and the survival of the patients at stages A, B and C was analyzed. The justification of the BCLC staging system was re-evaluated. Fifty-two patients were classified at stage A, 51 at stage B and 17 at stage C respectively. The hospital mortality of this cohort was zero and the morbidity was 24.1%. The 1-, 2-, 3-year overall survival rate of this cohort was 81.6%, 68.3%, and 57.5% respectively. There was no signifi-cant difference in the survival rate between the patients at stage A and B （P〉0.05）. If the treatment guidelines of BCLC staging system were followed, the majority of the patients at stages A and B （77.7%, 80/103） would not have been treated surgically. Our data suggest that the surgical indications of the BCLC staging system are not justified for HCC treatment. More studies may be needed as for how to further broaden the surgical indications of the BCLC staging system in the future.
基金supported by grants from You’an Liver disease/AIDS funding(2011)the National Science&Technology Pillar Program during the 12th Five-year Plan Period(2013BAI13B04)
文摘BACKGROUND： The Barcelona Clinic Liver Cancer（BCLC）staging system for hepatocellular carcinoma（HCC） recommends transarterial chemoembolization（TACE） as the first line therapy for stage B patients and sorafenib treatment for stage C patients.However, stage C patients exhibit variations in terms of tumor burden, liver function, and extrahepatic metastasis, which could potentially affect disease outcome. Here, we assessed whether the Cancer of the Liver Italian Program（CLIP） scores can help identify stage C patients likely to benefit from TACE.METHODS： Out of 295 BCLC stage C HCC patients enrolled between January 2009 and December 2011, those with platelet counts 〉30×10~9 cells/L, total bilirubin 〈51 μmo L/L, and an unobstructed main portal vein were scheduled for TACE（n=195）. The remaining patients received best supportive care（BSC, n=100）.All the patients were followed up for symptoms, performance status, and Child-Pugh classification scores every 4 weeks until death or December 2013. The prognosis of each group was evaluated by using the log-rank test and Cox-Mantel test.RESULTS： The median overall survival（OS） was 6 months [95% confidence interval（CI）： 4.64-7.36]. The OS was 9 months for the TACE group and 4 months for the BSC group. The TACE group had a longer OS than the BSC subgroup for CLIP scores 0-2 [13 months（95% CI： 8.55-17.45） vs 4 months（95% CI：0.00-10.96）, P=0.001]. No significant differences were found between the TACE and BSC groups for CLIP scores 3-5. The CLIP score and treatment methods were found to be independent prognostic factors.CONCLUSIONS： BCLC stage C HCC patients exhibit definite disease heterogeneity and can be reclassified by using the CLIP scoring system. Moreover, patients with CLIP scores 0-2 are likely to benefit from TACE. However, additional studies with long-term follow-up will be required to validate these findings.
基金supported by grants from the Sichuan Science and Technology Program(2023YFQ0094)the 1.3.5 project for disciplines of excellence,West China Hospital,Sichuan University(25HXJS028).
文摘Background:According to the 2022 update of the BCLC strategy,laparoscopic liver resection(LLR)is considered feasible for BCLC stage 0-A hepatocellular carcinoma(HCC)patients with clinically significant portal hypertension(CSPH).However,there is still no research to explore the outcomes of laparoscopic versus open liver resection(OLR)in the specific patients with BCLC stage 0-A HCC and CSPH.Methods:Patients diagnosed with BCLC stage 0-A HCC and CSPH who underwent liver resection at West China Hospital of Sichuan University from February 2018 to December 2022 were analyzed.Demographic characteristics,pathological findings and postoperative outcomes were compared using propensity score matching(PSM).Long-term outcomes after surgery were analyzed using Kaplan-Meier analysis both before and after PSM.Results:A total of 409 patients,including 261 LLRs and 148 OLRs,were enrolled in this study.There were imbalances between the groups in baseline information.After 1:1 PSM,118 patients were included in each group with comparable baseline characteristics.Patients in the LLR group had significantly less intraoperative blood loss compared to those in the OLR group(median 223 vs.318 mL,P<0.001),and fewer postoperative complications(33.9%vs.57.6%,P<0.001),including lower rates of postoperative liver decompensation(16.9%vs.28.0%,P=0.043),postoperative ascites(18.6%vs.31.4%,P=0.024)and pulmonary infections(12.7%vs.29.7%,P=0.001).The long-term follow-up showed that overall survival(P=0.154)and recurrence-free survival(P=0.376)were comparable between the two groups.In subgroup analysis,patients with PLT≤75×10^(9)/L suffered more postoperative liver decompensation(PLD)and ascites than patiens with PLT>75×10^(9)/L.Conclusions:Compared with OLR,LLR had less intraoperative blood loss,fewer postoperative complications and comparable oncological outcomes for patients with BCLC stage 0/A HCC and CSPH.
文摘Hepatocellular carcinoma(HCC)is the third-leading cause of cancer-related mortality worldwide(1).While upfront surgical resection has been established as an effective curative treatment for early-stage disease,up to 53.6%of patients present with moderate-to-advanced stage disease(2).Traditional recommendations as per the latest Barcelona Clinic Liver Cancer(BCLC)2022 update have advised for palliative transarterial chemoembolization(TACE)or systemic treatment(3),leaving this patient group with only modest response rates of 5%to 40%(4).However,with oncological advancements in recent years,conversion therapy has emerged as an effective strategy to change the therapeutic trajectory of patients with BCLC stage B and BCLC stage C HCC,showing significantly improved long-term outcomes compared to systemic therapy alone(5).
基金This work was supported by grants from the Health and Welfare Surcharge of Tobacco Products,Ministry of Health and Welfare,Taiwan(Nos.MOHW107-TDU-B-212-114022,MOHW108-TDU-B-212-124022,MOHW109-TDU-B-212-134022 to Chen CL).
文摘Background:Barcelona clinic liver cancer(BCLC)stage B(intermediate stage)hepatocellular carcinoma(HCC)is highly heterogeneous;thus,identifying the most effective treatment for individual patients represents a significant clinical challenge.However,transarterial chemoembolization(TACE)is the only recommended treatment option.Therefore,we aimed to investigate the patient characteristics and outcomes of living donor liver transplantation(LDLT)for BCLC stage B HCC.Methods:A total of 516 patients with BCLC stage B HCC who underwent LDLT(n=104)or did not undergo LDLT(non-LDLT;n=412)between 2004 to 2018 were analyzed by propensity score matching(PSM;1:4)analysis.Factors influencing overall survival(OS)and recurrence were analyzed using Cox’s proportional hazards models.Results:Patients treated with LDLT achieved better OS than the non-LDLT group,including liver-and non-liver related survival(all P<0.001).Multivariate Cox regression analysis showed age>60 years(P=0.006),a neutrophil-lymphocyte ratio(NLR)>4(P=0.016)and>3 locoregional therapies(LRT)before LDLT(P<0.001)were independent risk factors for HCC recurrence.In addition,age>60 years(P<0.001)and>3 LRT before LDLT(P=0.001)were independent risk factors for OS.Using a combination of age,NLR,and LRT before liver transplantation(LT),the patients can be divided into low-risk(none of risk),intermediate-risk(one of risk),and high risk(more than two of risk)groups.There were significant differences in the cumulative HCC recurrence(P<0.001)and mortality(P<0.001)rates among the three groups.Conclusions:LDLT may represent a valuable therapeutic option for selected patients with BCLC stage B HCC.
文摘At the beginning of the 21st century,in a global attempt to guide and organize the treatment of hepatocellular carcinoma(HCC),which had reached 7th place as the most frequent cancer due to the historical coincidence of three confluent pandemics worldwide(alcoholism,obesity and viral hepatitis),several HCC classification proposals arose,among them,the one elaborated by Llovet et al.,members of the Liver Unit of Barcelona Clinic Hospital,who published the first version of the Barcelona Clinic Liver Cancer(BCLC)in 1999.
基金Basic Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Science and ICT(No.NRF-2023R1A2C2005946).Korean NRF did not influence the drafting of the manuscript.
文摘For intermediate-stage hepatocellular carcinoma(HCC)in the Barcelona Clinic Liver Cancer(BCLC),transarterial chemoembolization(TACE)is advised as the initial treatment.The term“BCLC intermediate-stage HCC”(BCLC stage B)refers to a group of patients with varying liver functions and single big nodules or many nodules that do not have distant metastases or vascular invasion(1).In general,tumors beyond the Milan criteria(single tumor>5 cm or≥4 nodules)are classified as BCLC intermediate-stage HCC.Consequently,not every patient with intermediate-stage HCC in BCLC is a good candidate for TACE alone;this is especially true for patients who have a substantial tumor bulk,multinodular dissemination,or decreased liver function.TACE refractory cases cannot get full TACE treatment.
