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A Conceptual Classification of Resectability for Hepatocellular Carcinoma

BACKGROUNDS: In the era of multidisciplinary treatment strategy, resectability for hepatocellular carcinoma (HCC) should be defined. This study aimed to propose and validate a resectability classification of HCC. METHODS: We proposed following the three groups; resectable-(R), borderline resectable-...

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Autores principales: Yoh, Tomoaki, Ishii, Takamichi, Nishio, Takahiro, Koyama, Yukinori, Ogiso, Satoshi, Fukumitsu, Ken, Uchida, Yoichiro, Ito, Takashi, Seo, Satoru, Hata, Koichiro, Hatano, Etsuro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9895025/
https://www.ncbi.nlm.nih.gov/pubmed/36287266
http://dx.doi.org/10.1007/s00268-022-06803-7
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author Yoh, Tomoaki
Ishii, Takamichi
Nishio, Takahiro
Koyama, Yukinori
Ogiso, Satoshi
Fukumitsu, Ken
Uchida, Yoichiro
Ito, Takashi
Seo, Satoru
Hata, Koichiro
Hatano, Etsuro
author_facet Yoh, Tomoaki
Ishii, Takamichi
Nishio, Takahiro
Koyama, Yukinori
Ogiso, Satoshi
Fukumitsu, Ken
Uchida, Yoichiro
Ito, Takashi
Seo, Satoru
Hata, Koichiro
Hatano, Etsuro
author_sort Yoh, Tomoaki
collection PubMed
description BACKGROUNDS: In the era of multidisciplinary treatment strategy, resectability for hepatocellular carcinoma (HCC) should be defined. This study aimed to propose and validate a resectability classification of HCC. METHODS: We proposed following the three groups; resectable-(R), borderline resectable-(BR), and unresectable (UR)-HCCs. Resectable two groups were sub-divided according to the value of indocyanine green clearance of remnant liver (ICG-Krem) and presence of macrovascular invasion (MVI); BR-HCC was defined as resectable HCCs with MVI and/or ICG-Krem≥0.03–<0.05, and R-HCC was the remaining. Consecutive patients with HCC who underwent liver resection (LR) and non-surgical treatment(s) (i.e., UR-HCC) between 2011 and 2017 were retrospectively analyzed to validate the proposed classification. RESULTS: A total of 361 patients were enrolled in the study. Of these, R-, BR- and UR-HCC were found in 251, 46, and 64 patients, respectively. In patients with resected HCC, ICG-Krem≥0.05 was associated with decreased risk of clinically relevant posthepatectomy liver failure (p=0.013) and the presence of MVI was associated with worse overall survival (OS) (p<0.001). The 3–5-years OS rates according to the proposed classification were 80.3, and 68.3% versus 51.4, and 35.6%, in the R and BR groups, respectively (both p<0.001). Multivariate analysis showed BR-HCC was independently associated with poorer OS (p<0.001) after adjusting for known tumor prognostic factors. Meanwhile, BR-HCC was associated with benefit in terms of OS compared with UR-HCC (p<0.001). CONCLUSION: Our proposal of resectability for HCC allows for stratifying survival outcomes of HCC and may help to determine treatment strategy. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00268-022-06803-7.
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spelling pubmed-98950252023-02-04 A Conceptual Classification of Resectability for Hepatocellular Carcinoma Yoh, Tomoaki Ishii, Takamichi Nishio, Takahiro Koyama, Yukinori Ogiso, Satoshi Fukumitsu, Ken Uchida, Yoichiro Ito, Takashi Seo, Satoru Hata, Koichiro Hatano, Etsuro World J Surg Original Scientific Report BACKGROUNDS: In the era of multidisciplinary treatment strategy, resectability for hepatocellular carcinoma (HCC) should be defined. This study aimed to propose and validate a resectability classification of HCC. METHODS: We proposed following the three groups; resectable-(R), borderline resectable-(BR), and unresectable (UR)-HCCs. Resectable two groups were sub-divided according to the value of indocyanine green clearance of remnant liver (ICG-Krem) and presence of macrovascular invasion (MVI); BR-HCC was defined as resectable HCCs with MVI and/or ICG-Krem≥0.03–<0.05, and R-HCC was the remaining. Consecutive patients with HCC who underwent liver resection (LR) and non-surgical treatment(s) (i.e., UR-HCC) between 2011 and 2017 were retrospectively analyzed to validate the proposed classification. RESULTS: A total of 361 patients were enrolled in the study. Of these, R-, BR- and UR-HCC were found in 251, 46, and 64 patients, respectively. In patients with resected HCC, ICG-Krem≥0.05 was associated with decreased risk of clinically relevant posthepatectomy liver failure (p=0.013) and the presence of MVI was associated with worse overall survival (OS) (p<0.001). The 3–5-years OS rates according to the proposed classification were 80.3, and 68.3% versus 51.4, and 35.6%, in the R and BR groups, respectively (both p<0.001). Multivariate analysis showed BR-HCC was independently associated with poorer OS (p<0.001) after adjusting for known tumor prognostic factors. Meanwhile, BR-HCC was associated with benefit in terms of OS compared with UR-HCC (p<0.001). CONCLUSION: Our proposal of resectability for HCC allows for stratifying survival outcomes of HCC and may help to determine treatment strategy. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00268-022-06803-7. Springer International Publishing 2022-10-26 2023 /pmc/articles/PMC9895025/ /pubmed/36287266 http://dx.doi.org/10.1007/s00268-022-06803-7 Text en © The Author(s) 2022, corrected publication 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Scientific Report
Yoh, Tomoaki
Ishii, Takamichi
Nishio, Takahiro
Koyama, Yukinori
Ogiso, Satoshi
Fukumitsu, Ken
Uchida, Yoichiro
Ito, Takashi
Seo, Satoru
Hata, Koichiro
Hatano, Etsuro
A Conceptual Classification of Resectability for Hepatocellular Carcinoma
title A Conceptual Classification of Resectability for Hepatocellular Carcinoma
title_full A Conceptual Classification of Resectability for Hepatocellular Carcinoma
title_fullStr A Conceptual Classification of Resectability for Hepatocellular Carcinoma
title_full_unstemmed A Conceptual Classification of Resectability for Hepatocellular Carcinoma
title_short A Conceptual Classification of Resectability for Hepatocellular Carcinoma
title_sort conceptual classification of resectability for hepatocellular carcinoma
topic Original Scientific Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9895025/
https://www.ncbi.nlm.nih.gov/pubmed/36287266
http://dx.doi.org/10.1007/s00268-022-06803-7
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