A classification model for resectability in hepatocellular carcinoma patients.

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Hepatocellular Carcinoma Research

Background:

• Hepatocellular carcinoma (HCC) resection outcomes vary significantly.
• Predicting patient outcomes after liver resection for HCC remains challenging.
• Existing classifications may not adequately stratify risk for all HCC patients.

Purpose of the Study:

• To propose and validate a novel resectability classification system for HCC.
• To differentiate between resectable (R-HCC), borderline resectable (BR-HCC), and unresectable (UR-HCC) cases.
• To improve patient selection for surgical intervention and neoadjuvant therapies.

Main Methods:

• A three-tiered classification (R, BR, UR) was developed for HCC.
• Patients undergoing hepatectomy were categorized and analyzed in training (n=409) and validation (n=295) cohorts.
• Classification criteria included macrovascular invasion, tumor size, and liver remnant scores.

Main Results:

• The classification identified 229 R-HCC and 56 BR-HCC patients in the training cohort.
• BR-HCC patients exhibited significantly worse progression-free and overall survival than R-HCC patients (p < 0.0001).
• Tumor number and BR-HCC status were independent predictors of poor survival in multivariate analysis.

Conclusions:

• The proposed classification effectively stratifies HCC patients based on resectability.
• It aids in identifying BR-HCC patients who may benefit from preoperative treatment.
• This system can optimize treatment strategies and improve outcomes for HCC patients.