Tumor Number and Model for End-Stage Liver Disease Score as Selection Criteria for Resection or Embolization of Intermediate-Stage Hepatocellular Carcinoma.
Tumor and liver-related factors are well-known prognostic factors for patients with hepatocellular carcinoma (HCC). The Japanese Society of Hepatology (JSH) guidelines recommend considering liver resection (LR) for patients with multiple tumors and a tumor number ≤ 3. A previous Italian study showed that a model for end-stage liver disease (MELD) score of > 9 indicates inadequate liver function reserve in patients with HCC undergoing LR.
We used these two parameters to predict the overall survival (OS) of patients with Barcelona clinic liver cancer (BCLC) Stage B HCC who underwent LR or transcatheter arterial chemoembolization (TACE).
We consecutively enrolled patients with BCLC stage B HCC and Child-Pugh Class A liver disease underwent LR or TACE. Of these patients, 163 underwent LR and 270 underwent TACE. We used two parameters, that is, ≤ 3 nodules and a MELD score of ≤ 9, to subclassify BCLC stage B HCC patients. BCLC B1 had to occur concomitantly with two parameters, whereas for BCLC B2, meeting only one criterion was sufficient. The five-year OS of BCLC B1 patients undergoing LR was 60% and those undergoing TACE was 37% (p = 0.007). The 5-year OS of BCLC B2 patients undergoing LR was 23% and those undergoing TACE was 18% (p = 0.223).
We recommend considering LR for BCLC B1 patients, whereas TACE could be considered for BCLC B2 patients.
We used these two parameters to predict the overall survival (OS) of patients with Barcelona clinic liver cancer (BCLC) Stage B HCC who underwent LR or transcatheter arterial chemoembolization (TACE).
We consecutively enrolled patients with BCLC stage B HCC and Child-Pugh Class A liver disease underwent LR or TACE. Of these patients, 163 underwent LR and 270 underwent TACE. We used two parameters, that is, ≤ 3 nodules and a MELD score of ≤ 9, to subclassify BCLC stage B HCC patients. BCLC B1 had to occur concomitantly with two parameters, whereas for BCLC B2, meeting only one criterion was sufficient. The five-year OS of BCLC B1 patients undergoing LR was 60% and those undergoing TACE was 37% (p = 0.007). The 5-year OS of BCLC B2 patients undergoing LR was 23% and those undergoing TACE was 18% (p = 0.223).
We recommend considering LR for BCLC B1 patients, whereas TACE could be considered for BCLC B2 patients.