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Updated: Dec 26, 2025
A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma
Published on: September 30, 2021
Hepatocellular carcinoma surgical and oncological trends in a national multicentric population: the HERCOLES
Simone Famularo1,2, Matteo Donadon3, Federica Cipriani4
1School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy. simone.famularo@gmail.com.
Insights
This study reports on Italian liver surgery for hepatocellular carcinoma (HCC), showing good outcomes with low complications. It highlights trends in surgical and oncological results for HCC patients.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Liver surgery is the primary treatment for hepatocarcinoma.
- The Hepatocarcinoma Recurrence on the Liver Study (HERCOLES) Group was formed to create a network for HCC research in Italy.
- This report analyzes national trends in surgical and oncological outcomes for HCC.
Purpose of the Study:
- To analyze surgical and oncological outcomes in patients undergoing liver surgery for HCC.
- To present the first national report on Italian experience in HCC surgical treatment.
- To establish a network for data sharing and research in HCC.
Main Methods:
- Data collected from 22 Italian centers between 2008 and 2018.
- 164 variables recorded, including liver function, tumor burden, radiological, operative, and follow-up data.
- 2381 patients enrolled, with detailed demographic, clinical, and pathological information.
Main Results:
- Median patient age was 70; 62.6% had cirrhosis, 89.9% were Child-A.
- 50% of HCC cases were BCLC 0-A stage; major resections in 20.2%, laparoscopy in 31.6%.
- Severe complications at 5%, 90-day mortality at 2.5%. 5-year overall survival 66.1%, disease-free survival 40.9%. Intrahepatic recurrence in 74.6%.
Conclusions:
- This study represents the most current Italian report on surgical HCC treatment.
- The HERCOLES dataset enables multicenter analyses with significant statistical power.
- Surgical treatment for HCC in Italy demonstrates favorable outcomes and manageable complication rates.
Abstract:
Liver surgery is the first line treatment for hepatocarcinoma. Hepatocarcinoma Recurrence on the Liver Study (HERCOLES) Group was established in 2018 with the goal to create a network of Italian centres sharing data and promoting scientific research on hepatocellular carcinoma (HCC) in the surgical field. This is the first national report that analyses the trends in surgical and oncological outcomes. Register data were collected by 22 Italian centres between 2008 and 2018. One hundred sixty-four variables were collected, regarding liver functional status, tumour burden, radiological, intraoperative and perioperative data, histological features and oncological follow-up. 2381 Patients were enrolled. Median age was 70 (IQR 63-75) years old. Cirrhosis was present in 1491 patients (62.6%), and Child-A were 89.9% of cases. HCC was staged as BCLC0-A in almost 50% of cases, while BCLC B and C were 20.7% and 17.9% respectively. Major liver resections were 481 (20.2%), and laparoscopy was employed in 753 (31.6%) cases. Severe complications occurred only in 5%. Postoperative ascites was recorded in 10.5% of patients, while posthepatectomy liver failure was observed in 4.9%. Ninety-day mortality was 2.5%. At 5 years, overall survival was 66.1% and disease-free survival was 40.9%. Recurrence was intrahepatic in 74.6% of cases. Redo-surgery and thermoablation for recurrence were performed up to 32% of cases. This is the most updated Italian report of the national experience in surgical treatment for HCC. This dataset is consistently allowing the participating centres in creating multicentric analysis which are already running with a very large sample size and strong power.
