New Hepatic Resection Criteria for Intermediate-Stage Hepatocellular Carcinoma Can Improve Long-Term Survival: A Retrospective, Multicenter Collaborative Study

BACKGROUND: Hepatic resection (HR) is not recommended for intermediate-stage hepatocellular carcinoma (HCC) by the Barcelona Clinic Liver Cancer criteria. We examined the prognostic factors of HR for intermediate-stage HCC and developed new HR criteria for intermediate-stage HCC. METHODS: A total of 110 patients who underwent HR without any prior treatment for intermediate-stage HCC between January 2007 and December 2012 were enrolled at eight university hospitals. The outcomes and prognostic factors of HR were evaluated to develop new HR criteria. RESULTS: In terms of tumor size and number, the most significant prognostic factors were within the up-to-seven criteria. Furthermore, serum albumin level ≥35 g/L and serum alpha-fetoprotein (AFP) level <100 µg/L were prognostic factors in multivariate analysis. The 5-year cumulative survival rate of patients based on the new HR criteria (i.e., up-to-seven, AFP <100 µg/L, albumin ≥35 g/L) was 81.4% and the area under the curve was 0.653. CONCLUSIONS: HR can improve the prognosis of patients with intermediate-stage HCC who meet the up-to-seven criteria and have serum albumin levels ≥35 g/L and serum AFP levels <100 µg/L. These factors could serve as new HR criteria for intermediate-stage HCC.