Evaluating the Ability of the New Subclassification to Prognosticate Outcomes Following Hepatectomy for Patients with HBV-Related HCC.

BACKGROUND: Recently, experts proposed subclassification for BCLC B patients. In this study, we aimed to evaluate the efficient of subclassification of patients with hepatitis B virus-related hepatocellular carcinoma (HCC) in Barcelona Clinic Liver Cancer (BCLC) staging system. METHODS: Seven hundred twenty-nine consecutive hepatitis B virus-related HCC patients with BCLC stage B classification who underwent hepatectomy in the period 2006-2012 were retrospectively analyzed. Patients were reclassified based on the new proposed subclassification of the BCLC B stage from B1 to B4. The prognosis of subclassification was tested using Kaplan-Meier statistics analysis. RESULTS: There were 145 (19.9%), 480 (65.8%), 62 (8.5%), and 42 (5.8%) patients in B1, B2, B3, and B4, respectively. The result suggested that overall and tumor-free survival rates among the B1, B2, and B3 subclassification in the Bolondi system had significant difference (P < 0.05). However, no significant difference was found between B3 and B4 subclassifications. Cox regression showed that BCLC B subclassification, largest/smallest diameter, and anatomic liver resection were independent predictors of tumor-free survival. BCLC B subclassification and anatomic liver resection were independent predictors of overall survival. CONCLUSIONS: The subclassification of BCLC stage B can be used in patients with HBV-related HCC who underwent curative intent hepatectomy. Patients in BCLC B1 and B2 subgroups should be treated more aggressively than patients in B3 and B4 subgroups. B3 and B4 groups should be merged for patients with HBV-related HCC who underwent curative intent hepatectomy.

Prognosis in patients with small hepatocellular carcinoma: a meta-analysis.

BACKGROUND/AIMS: To evaluate the impact of anatomic and non-anatomic liver resection on prognosis of patients with small hepatocellular carcinoma (HCC) using a meta-analysis. METHODOLOGY: Literature on anatomic versus non-anatomic liver resection for the treatment of small HCC published in public was retrieved. RESULTS: Four non-randomized controlled trials studies were included in this analysis. These studies included a total of 776 patients: 484 treated with anatomic liver resection and 282 treated with non-anatomic resection. No significant differences were found concerning the 1, 3 and 5-year disease-free survival rate between the two groups. There was no significant difference between the two groups when comparing the 1, 3 and 5-year overall survival rate. We use the sensitivity analysis which found anatomic resection could extend the 3-year disease-free survival rate when compared with non-anatomic resection (odds ratio (OR)=0.72, 95% confidence interval (CI): 0.52-0.99, p=0.04). CONCLUSIONS: Anatomic liver resection can extend the 3-year disease-free survival rate of patients with small hepatocellular carcinoma. Further randomized controlled trials are needed to define the exact value of anatomic resection and non-anatomic resection for small HCC.