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Surgical Outcomes for Hepatocellular Carcinoma in Patients with Child-Pugh Class B: a Retrospective Multicenter Study
Shogo Tanaka1, Takehiro Noda2, Koji Komeda3
1Department of Hepato-Biliary-Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-Ku, Osaka, 545-8585, Japan. shogotanaka@omu.ac.jp.
Insights
Liver resection for hepatocellular carcinoma in Child-Pugh class B patients carries risks. Albumin-bilirubin grade III and high alpha-fetoprotein levels indicate unfavorable outcomes, impacting recurrence and survival.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Liver resection for hepatocellular carcinoma (HCC) in Child-Pugh class B (CPC B) patients is associated with increased postoperative complications, mortality, and reduced survival compared to CPC A.
- Selected CPC B patients may still benefit from liver resection.
Purpose of the Study:
- To analyze the risks of postoperative complications, recurrence, and death in CPC B patients undergoing liver resection for HCC.
- To identify independent risk factors for adverse outcomes after liver resection in this patient group.
Main Methods:
- Retrospective review of clinical records for 114 CPC B patients who underwent liver resection for HCC.
- Analysis of postoperative complications (Clavien-Dindo grade ≥ II), recurrence, and mortality.
- Multivariate analysis to identify independent risk factors.
Main Results:
- Postoperative complications occurred in 31.6% of patients; 2 deaths were reported within 90 days.
- Independent risk factors for complications included Albumin-Bilirubin (ALBI) grade III and extended operation time.
- Disease-free survival (DFS) and overall survival (OS) at 3/5 years were 30.8%/25.3% and 68.4%/48.9%, respectively.
- Independent risk factors for recurrence were extended blood loss, high alpha-fetoprotein (AFP) levels (≥ 200 ng/mL), and Barcelona Clinic Liver Cancer stage C.
- High AFP levels were also an independent prognostic factor for OS and associated with earlier recurrence and more extrahepatic spread.
Conclusions:
- ALBI grade III and high AFP levels are unfavorable prognostic indicators for CPC B patients undergoing liver resection for HCC.
- These factors should be considered when assessing surgical candidacy and managing postoperative expectations.
Backgrounds:
Liver resection for hepatocellular carcinoma (HCC) in patients with Child-Pugh class (CPC) B increases the incidence of postoperative complication and in-hospital death and decreases the disease-free survival (DFS) and overall survival (OS) compared with those with CPC A. Conversely, some selected patients possibly gained benefits for liver resection.
Methods:
Clinical records of 114 patients with CPC B who underwent liver resection for HCC were retrospectively reviewed. The risk of postoperative complications (Clavien-Dindo classification grade of ≥ II), postoperative recurrence, and death was analyzed.
Results:
Postoperative complications occurred in 36 patients (31.6%), and 2 died within 90 days postoperatively due to the liver and respiratory failure, respectively. Multivariate analysis indicated that albumin-bilirubin (ALB) grade III and extended operation time were found as independent risk factors for postoperative complications. The DFS and OS rates at 3/5 years after liver resection were 30.8%/25.3% and 68.4%/48.9%, respectively. Multivariate analysis indicated that the extended blood loss, high α-fetoprotein (AFP) level (≥ 200 ng/mL), and Barcelona Clinic Liver Cancer stage C were found to be independent risk factors for postoperative recurrence. The high AFP level was also an independent prognostic factor for OS. Patients with high AFP levels had postoperative recurrence within 2 years and a higher number of extrahepatic recurrences than those with low AFP levels (< 200 ng/mL).
Conclusion:
For patients with HCC with CPC B who were scheduled for liver resection, ALBI grade III and high AFP level should be considered as unfavorable outcomes after liver resection.
