Prognostic Stratification of Initial Treatments for Hepatocellular Carcinoma Using a Modified Borderline Resectable...

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Gastroenterology

Background:

• Japanese expert consensus established borderline resectable (BR) criteria for hepatocellular carcinoma (HCC).
• Additional classification is needed for precise clinical practice.
• The prognostic value of modified BR (mBR) criteria requires evaluation.

Purpose of the Study:

• To assess the prognostic predictive value of the modified BR (mBR) criteria in treatment-naïve HCC patients.
• To refine HCC patient stratification beyond the original BR classification.

Main Methods:

• Retrospective analysis of 1056 treatment-naïve HCC patients (Child-Pugh A) from 2009-2024.
• Modified BR (mBR) criteria categorized patients into resectable, mBR1, mBR2, and boldly BR (BBR) groups (with EHM).
• Treatments included curative (Cur), non-curative (NC), and best supportive care (BSC).

Main Results:

• Overall survival (OS) significantly differed across mBR categories (resectable/mBR1/mBR2/BBR: 113.3/49.4/30.1/10.3 months).
• Tumor markers (AFP, AFP-L3, PIVKA-II) and albumin-bilirubin scores showed progressive worsening with advanced mBR categories (p < 0.001).
• Curative treatment yielded superior OS in resectable, mBR1, and mBR2 groups; BBR patients showed no prognostic benefit from treatment modality.

Conclusions:

• The mBR criteria provide valuable prognostic stratification for HCC patients.
• Aggressive surgical resection may be a viable initial option for advanced HCC, excluding EHM cases.
• Further studies are needed for direct comparisons of treatment modalities in BBR patients.