The role of resection in hepatocellular carcinoma BCLC stage B: A multi-institutional patient-level meta-analysis and systematic review ( vol 409 , 277 , 2024)

被引:0
|
作者
Lopez-Lopez, Victor [1 ]
Kalt, Fabian [2 ,3 ]
Zhong, Jian-Hong [4 ]
Guidetti, Cristiano [5 ]
Magistri, Paolo [5 ]
Di Benedetto, Fabrizio [5 ]
Weinmann, Arndt [6 ]
Mittler, Jens [7 ]
Lang, Hauke [7 ]
Sharma, Rohini [8 ]
Vithayathil, Mathew [8 ]
Tariq, Samir [8 ]
Sanchez-Velazquez, Patricia [9 ]
Rompianesi, Gianluca [10 ]
Troisi, Roberto Ivan [10 ]
Gomez-Gavara, Concepcion [11 ]
Dalmau, Mar [11 ]
Sanchez-Romero, Francisco Jose [2 ,3 ]
Llamoza, Camilo [2 ,3 ]
Tschuor, Christoph [11 ]
Deniz, Uluk
Lurje, Georg
Husen, Peri
Hugli, Sandro [1 ]
Jonas, Jan Philipp [2 ,3 ]
Rossler, Fabian [2 ,3 ]
Kron, Philipp [2 ,3 ]
Ramser, Michaela [2 ,3 ]
Ramirez, Pablo [2 ,3 ]
Lehmann, Kuno [2 ,3 ]
Robles-Campos, Ricardo [1 ]
Eshmuminov, Dilmurodjon [2 ,3 ]
机构
[1] Clin & Univ Hosp Virgen La Arrixaca, Dept Gen Visceral & Transplantat Surg, IMIB-ARRIXACA, El Palmar, Murcia, Spain
[2] Univ Hosp Zurich, Dept Surg & Transplantat, Raemistr 100, CH-8091 Zurich, Switzerland
[3] Univ Zurich, Raemistr 100, CH-8091 Zurich, Switzerland
[4] Guangxi Med Univ, Dept Hepatobiliary Surg, Canc Hosp, Nanning 530021, Peoples R China
[5] Univ Modena & Reggio Emilia, Hepatopancreato Biliary Surg & Liver Transplantat, Modena, Italy
[6] Johannes Gutenberg Univ Mainz, Dept Internal Med 1, Univ Med Ctr, Mainz, Germany
[7] Johannes Gutenberg Univ Mainz, Univ Med Ctr, Dept Gen Visceral & Transplant Surg, D-55131 Mainz, Germany
[8] Imperial Coll London, Dept Surg & Canc, London, England
[9] Univ Pompeu Fabra, Hosp Mar, Div Hepatobliary & Pancreat Surg, IMIM, Barcelona, Spain
[10] Federico II Univ Naples, Dept Clin Med & Surg, Naples, Italy
[11] Univ Autonoma Barcelona, Hosp Vall dHebron, Dept HPB & Transplantat Surg, Barcelona, Spain
关键词
HCC; BCLC-B; Liver resection; Liver transplantation;
D O I
10.1007/s00423-024-03518-2
中图分类号
R61 [外科手术学];
学科分类号
摘要
PurposeThe Barcelona Clinic Liver Cancer (BCLC) staging schema is widely used for hepatocellular carcinoma (HCC) treatment. In the updated recommendations, HCC BCLC stage B can become candidates for transplantation. In contrast, hepatectomy is currently not recommended.MethodsThis systematic review includes a multi-institutional meta-analysis of patient-level data. Survival, postoperative mortality, morbidity and patient selection criteria for liver resection and transplantation in BCLC stage B are explored. All clinical studies reporting HCC patients with BCLC stage B undergoing liver resection or transplantation were included.ResultsA total of 31 studies with 3163 patients were included. Patient level data was available for 580 patients from 9 studies (423 after resection and 157 after transplantation). The overall survival following resection was 50 months and recurrence-free survival was 15 months. Overall survival after transplantation was not reached and recurrence-free survival was 45 months. The major complication rate after resection was 0.11 (95%-CI, 0.0-0.17) with the 90-day mortality rate of 0.03 (95%-CI, 0.03-0.08). Child-Pugh A (93%), minor resection (60%), alpha protein level less than 400 (64%) were common in resected patients. Resected patients were mostly outside the Milan criteria (99%) with mean tumour number of 2.9. Studies reporting liver transplantation in BCLC stage B were scarce.ConclusionLiver resection can be performed safely in selected patients with HCC BCLC stage B, particularly if patients present with preserved liver function. No conclusion can done on liver transplantation due to scarcity of reported studies.
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页数:2
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