Surgical Outcomes and Recurrence Management in Borderline Resectable Hepatocellular Carcinoma: Implications for Multidisciplinary Strategies

IF 3.2 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery Pub Date : 2026-07-02 Epub Date: 2026-01-20 DOI:10.1002/ags3.70177

Koichiro Haruki, Kenei Furukawa, Munetoshi Akaoka, Yuto Yamahata, Shinji Onda, Yoshihiro Shirai, Masashi Tsunematsu, Tomohiko Taniai, Michinori Matsumoto, Toru Ikegami

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Abstract

Background

Oncological resectability classification for hepatocellular carcinoma (HCC) emphasizes the need to reassess treatment strategies for borderline resectable (BR) cases. This study evaluated surgical outcomes and prognostic factors in BR-HCC and reconsidered multidisciplinary approaches for recurrence management.

Methods

The study comprised 433 patients who underwent primary hepatic resection for HCC between 2000 and 2023. Patients were classified as R, BR1, and BR2 according to the Expert Consensus Statement 2023. Multivariate Cox proportional hazard models were conducted to identify prognostic factors for disease-free and overall survival in BR (BR1 + BR2) patients.

Results

Among 70 patients with BR-HCC (BR1: n = 37, BR2: n = 33), 5-year overall survival was 53% in BR1 versus 22% in BR2 patients (p = 0.06). In multivariate analysis, up-to-7 out (p < 0.001) and lymph node metastasis (p < 0.001) were independent predictors of cancer recurrence, whereas anatomical resection was associated with improved disease-free survival (p = 0.02). Independent predictors of overall survival included older age (p = 0.01), Child-Pugh B (p < 0.001), up-to-7 out (p = 0.01), macrovascular invasion (p = 0.01), and lymph node metastasis (p < 0.001). Recurrence occurred in 89% of BR-HCC patients, with BR2 showing more frequent early recurrence within 1 year (p = 0.006) and recurrence beyond Milan criteria (p = 0.02) compared to BR1. Patients receiving surgical resection or radiofrequency ablation for recurrence demonstrated better survival compared with other treatments (p < 0.001).

Conclusions

BR1 and BR2-HCC represent biologically aggressive subsets with high recurrence rates and poor prognosis, particularly in tumors with up-to-7 out status, lymph node metastasis, and macrovascular invasion. Active salvage treatment for recurrence may improve survival, highlighting the importance of multidisciplinary approaches in BR-HCC management.

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交界性可切除肝细胞癌的手术结果和复发管理：多学科策略的意义

背景：肝细胞癌（HCC）的肿瘤可切除性分类强调需要重新评估边缘性可切除（BR）病例的治疗策略。本研究评估了BR-HCC的手术结果和预后因素，并重新考虑了复发治疗的多学科方法。方法：该研究纳入了2000年至2023年间接受原发性肝切除术的433例HCC患者。根据专家共识声明2023将患者分为R、BR1和BR2。采用多变量Cox比例风险模型来确定影响BR （BR1 + BR2）患者无病生存和总生存的预后因素。结果在70例BR-HCC患者（BR1: n = 37, BR2: n = 33）中，BR1患者的5年总生存率为53%，BR2患者为22% （p = 0.06）。在多变量分析中，up- 7 out （p < 0.001）和淋巴结转移（p < 0.001）是癌症复发的独立预测因子，而解剖切除与改善无病生存相关（p = 0.02）。总生存率的独立预测因子包括年龄较大（p = 0.01）、Child-Pugh B （p < 0.001）、up- 7 out （p = 0.01）、大血管侵袭（p = 0.01）和淋巴结转移（p < 0.001）。89%的BR-HCC患者出现复发，与BR1相比，BR2在1年内早期复发的频率更高（p = 0.006），复发超出米兰标准（p = 0.02）。与其他治疗方法相比，接受手术切除或射频消融治疗复发的患者生存率更高（p < 0.001）。结论BR1和br2 hcc是具有生物侵袭性的亚群，复发率高，预后差，特别是在7 - out状态、淋巴结转移和大血管侵犯的肿瘤中。复发的积极救助治疗可能提高生存率，强调了多学科方法在BR-HCC治疗中的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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