Chronological evolution in liver resection for hepatocellular carcinoma: Prognostic trends across three decades in early to advanced stages

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso Pub Date : 2025-02-01 DOI:10.1016/j.ejso.2024.109461

Takeshi Takamoto , Satoshi Nara , Daisuke Ban , Takahiro Mizui , Masami Mukai , Minoru Esaki , Kazuaki Shimada

{"title":"Chronological evolution in liver resection for hepatocellular carcinoma: Prognostic trends across three decades in early to advanced stages","authors":"Takeshi Takamoto , Satoshi Nara , Daisuke Ban , Takahiro Mizui , Masami Mukai , Minoru Esaki , Kazuaki Shimada","doi":"10.1016/j.ejso.2024.109461","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>While liver resection remains the best curative option for hepatocellular carcinoma (HCC), it is unclear whether the consistent progress of multidisciplinary approaches in managing HCC over several decades has influenced the outcomes of liver resection.</div></div><div><h3>Methods</h3><div>Patients undergoing liver resection for HCC from 1993 to 2022 in our institution were retrospectively assessed and stratified into three periods according to the year of liver resection, P1 (1993–2000), P2 (2001–2009), and P3 (2010–2022), and tumor status using the Barcelona Clinic Liver Cancer (BCLC) staging system.</div></div><div><h3>Results</h3><div>A total of 1257 patients were included (P1:P2:P3 = 385:490:382, BCLC stage 0/A:B:C = 908:214:135). In the entire cohort, long-term surgical outcomes significantly improved across the three periods. In BCLC stage 0/A HCC, the 5-year overall survival (OS) rate improved from P1 to P3 (P1: 65.5 %, P2: 71.3 %, P3: 80.4 %), with HRs of 0.655 (95 % CI: 0.536 to 0.800) and 0.595 (95 % CI: 0.455 to 0.778) for P2 vs. P1 and P3 vs. P1, respectively. Conversely, limited advancements were observed in patients with BCLC stage B or C HCC. Multivariate analysis in BCLC stage 0/A patients demonstrated that ICGR15 > 15 %, ALBI grade 2 or 3 (vs. 1), multiple tumors, microvascular invasion, and surgical period (P2 vs.P1) remained independent poor prognostic factors for OS.</div></div><div><h3>Conclusions</h3><div>Substantial advancements in the long-term outcomes for HCC patients undergoing liver resection, particularly in BCLC stage 0/A, were observed, while minimal improvement was noted for BCLC stage B and C.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 2","pages":"Article 109461"},"PeriodicalIF":3.5000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Ejso","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0748798324015294","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

While liver resection remains the best curative option for hepatocellular carcinoma (HCC), it is unclear whether the consistent progress of multidisciplinary approaches in managing HCC over several decades has influenced the outcomes of liver resection.

Methods

Patients undergoing liver resection for HCC from 1993 to 2022 in our institution were retrospectively assessed and stratified into three periods according to the year of liver resection, P1 (1993–2000), P2 (2001–2009), and P3 (2010–2022), and tumor status using the Barcelona Clinic Liver Cancer (BCLC) staging system.

Results

A total of 1257 patients were included (P1:P2:P3 = 385:490:382, BCLC stage 0/A:B:C = 908:214:135). In the entire cohort, long-term surgical outcomes significantly improved across the three periods. In BCLC stage 0/A HCC, the 5-year overall survival (OS) rate improved from P1 to P3 (P1: 65.5 %, P2: 71.3 %, P3: 80.4 %), with HRs of 0.655 (95 % CI: 0.536 to 0.800) and 0.595 (95 % CI: 0.455 to 0.778) for P2 vs. P1 and P3 vs. P1, respectively. Conversely, limited advancements were observed in patients with BCLC stage B or C HCC. Multivariate analysis in BCLC stage 0/A patients demonstrated that ICGR15 > 15 %, ALBI grade 2 or 3 (vs. 1), multiple tumors, microvascular invasion, and surgical period (P2 vs.P1) remained independent poor prognostic factors for OS.

Conclusions

Substantial advancements in the long-term outcomes for HCC patients undergoing liver resection, particularly in BCLC stage 0/A, were observed, while minimal improvement was noted for BCLC stage B and C.

查看原文本刊更多论文

肝细胞癌肝切除术的时间演变：早期到晚期三十年的预后趋势。

背景：虽然肝切除术仍然是肝细胞癌（HCC）的最佳治疗选择，但目前尚不清楚几十年来多学科治疗方法在HCC治疗中的持续进展是否影响了肝切除术的结果。方法：采用巴塞罗那临床肝癌（BCLC）分期系统，对我院1993- 2022年行肝切除术的肝癌患者进行回顾性评估，并根据肝切除术年份P1（1993-2000）、P2（2001-2009）和P3（2010-2022）三个阶段及肿瘤状态进行分层。结果：共纳入1257例患者（P1:P2:P3 = 385:490:382， BCLC分期0/A:B:C = 908:214:135）。在整个队列中，三个时期的长期手术结果显著改善。在BCLC 0/A期HCC中，5年总生存率（OS）从P1提高到P3 (P1: 65.5%, P2: 71.3%, P3: 80.4%)， P2 vs P1和P3 vs P1的hr分别为0.655 （95% CI: 0.536 ~ 0.800）和0.595 （95% CI: 0.455 ~ 0.778）。相反，BCLC B期或C期HCC患者的进展有限。对BCLC 0/A期患者的多因素分析显示，ICGR15 bb0 15%、ALBI 2级或3级（vs. 1）、多发肿瘤、微血管侵犯和手术时间（P2 vs. p1）仍然是影响OS预后的独立因素。结论：观察到接受肝切除术的HCC患者的长期预后有实质性进展，特别是BCLC 0/A期，而BCLC B期和C期的改善很小。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Ejso 医学-外科

CiteScore

6.40

自引率

2.60%

发文量

1148

审稿时长

41 days

期刊介绍： JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery. The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.