Survival benefit of resectability determined by multiple surgeons in BCLC-C Stage: A single-center cohort study

Systemic therapy remains the standard treatment for Barcelona Clinic Liver Cancer Stage C (BCLC C). However, the heterogeneity of this patient cohort has prompted investigation into alternative or additional therapeutic approaches. Potential bias exists in previous comparisons among treatment groups. Therefore, we compared survival outcomes between resectable and unresectable groups, as determined by four experienced surgeons.

We used data from patients who were initially diagnosed with liver cancer and treated at Seoul National University Hospital from January 2015 to December 2017. Four experienced liver surgeons participated, and each patient was classified as 'resectable' only when the two reviewing surgeons agreed that it was 'resectable' based on medical records and imaging.

The cohort included 1351 patients, of whom 212 had BCLC C. Among them, 162 were classified as resectable and 50 as unresectable. Portal vein tumor thrombus was present in 92.6 % and 86 % in the unresectable and resectable groups, respectively. The resectable group had better survival rates than the unresectable group, with 1-, 3-, and 5-year survival rates of 75.4, 52.3, and 45.1 % vs. 47 %, 22.2 %, and 13 %, respectively (P < 0.01). In the resectable group, 21 patients underwent resection and 28 received transarterial chemoembolization. The resection subgroup demonstrated superior 1-, 3-, and 5-year survival rates: 90.2 %, 75.2 %, and 64.4 %, vs. 63.1 %, 33.4 %, and 28.7 %, respectively (P < 0.01). Bile duct invasion (HR: 0.6477 [1.309-32.05], P = 0.02) and resection (HR: 0.247 [0.072-0.854], P = 0.02) were significant factors for OS.

Determining resectability at the BCLC-C stage and performing resection may improve survival.