Development of novel biological resection criteria for safe and oncologically satisfying resection of hepatocellular carcinoma

Objective

To develop criteria for safe and oncologically satisfying liver resection in case of early hepatocellular carcinoma with a 5-year overall survival (OS) similar to liver transplantation.

Summary background data

Liver resection (LR) and liver transplantation (LT) are potentially curative treatment options for hepatocellular carcinoma. Generally, LT achieves better OS. Due to organ shortage, however not all patients can receive a LT.

Methods

To decide which patients to resect and which to transplant we have developed biological resection criteria (BRC) as a compound out of mGPS (modified Glascow Prognostic Scale) and the Kings-Score (for HCV cirrhosis). These are based on routine clinical values that reflect both liver function and tumor biology/immunology.

Results

276 patients were analyzed. Patients undergoing LR within BRC (_inBRC) had a significantly better overall (73.6% vs. 35.4%, (p?<?0.001)) and disease-free survival (54.7% vs. 17.2%, (p?<?0.001)) as compared to patients outside the BRC (_outBRC). The predictive value of BRC was independent of tumor burden. In a subgroup analysis _outBRC patients had significantly worse outcome after major resection. In LT patients BRC had no predictive value.

Conclusions

BRC may be a valuable tool to predict survival after LR for HCC. Patients resected _inBRC may achieve comparable survival as LT. LR in _outBRC patients are unlikely to be curative. All _outBRC patients should be monitored closely for salvage LT.