Survival benefit of liver resection for patients with hepatocellular carcinoma across different Barcelona Clinic Liver Cancer stages: a multicentre study

J Hepatol. 2015 Mar;62(3):617-24. doi: 10.1016/j.jhep.2014.10.037. Epub 2014 Oct 30.


Background & aims: The role of hepatic resection for hepatocellular carcinoma (HCC) in different Barcelona Clinic Liver Cancer (BCLC) stages is controversial. We aimed at measuring the survival benefit of resection vs. non-surgical-therapies in each BCLC stage.

Methods: Using the ITA.LI.CA database, we identified 2090 BCLC A, B, and C HCC patients observed between 2000 and 2012: 550 underwent resection, 1046 loco-regional therapy (LRT), and 494 best supportive care (BSC). A multivariate log-logistic model was chosen to predict median survival (MS) after resection vs. MS after LRT or BSC. The results were expressed as net survival benefit of resection: (MS resection-MS LRT)/MS BSC.

Results: After stratifying for BCLC stage, the median net survival benefit of resection over LRT was: BCLC 0=62% (40%, 82%), A=45% (13%, 65%), B=46% (9%, 76%), C=-16% (-55%, 33%). Model for end-stage liver disease (MELD) score>9, Child B class, and performance status (PST)=2 were the main risk factors for liver resection. 1181 Child A patients (57%) with MELD⩽9 and PST<2 had always a large positive net survival benefit of resection over LRT, independently of BCLC stage: BCLC 0=64% (44%, 85%), A=59% (45%, 74%), B=71% (52%, 90%), C=56% (36%, 78%). Among the 909 (43%) patients with at least one risk factor (MELD>9 or PST=2 or Child B class), resection did not prove any survival benefit over LRT.

Conclusions: Resection could result in survival benefit over LRT for HCC patients regardless of their BCLC stage, provided that liver dysfunction (Child B or MELD>9) and PST>1 are absent.

Keywords: Best supportive care; Cirrhosis; Hepatocellular carcinoma; Liver resection; Loco-regional therapies; Survival benefit.

Publication types

  • Clinical Study
  • Multicenter Study

MeSH terms

  • Aged
  • Carcinoma, Hepatocellular / mortality
  • Carcinoma, Hepatocellular / surgery*
  • Carcinoma, Hepatocellular / therapy
  • Cohort Studies
  • Female
  • Humans
  • Italy / epidemiology
  • Kaplan-Meier Estimate
  • Liver Neoplasms / mortality
  • Liver Neoplasms / surgery*
  • Liver Neoplasms / therapy
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Staging / methods
  • Prognosis
  • Treatment Outcome