Biologically Refined Oncological Resectability for Hepatocellular Carcinoma.

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Gastroenterology

Background:

• Established oncological resectability criteria for hepatocellular carcinoma (HCC) require further validation.
• Incorporating biological markers may enhance prognostic stratification for borderline-resectable HCC.

Purpose of the Study:

• To validate existing resectability criteria for HCC.
• To investigate the utility of biological factors, specifically alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP), in refining HCC resectability assessment.
• To improve the identification of borderline-resectable HCC and predict early recurrence.

Main Methods:

• Retrospective analysis of 391 patients undergoing initial hepatectomy for HCC (2009-2022).
• Patients classified as resectable (R), borderline-resectable (BR1), or BR2.
• Subclassification of R-group patients with high AFP (≥400 ng/mL) and DCP (≥400 mAU/mL) as biological-BR.
• Comparison of overall survival (OS) and recurrence-free survival (RFS) with the Barcelona Clinic Liver Cancer (BCLC) staging system.
• Evaluation of time-dependent prediction of 6-month recurrence using receiver operating characteristic (ROC) curves and net reclassification improvement (NRI).

Main Results:

• Survival stratification using initial criteria was comparable to BCLC staging.
• Twenty-six R-group patients were reclassified as biological-BR, exhibiting higher rates of microvascular invasion (42.3%).
• Biological-BR patients had survival outcomes similar to BR1 patients.
• Combining biological-BR with BR1 significantly improved the prediction of 6-month recurrence (ROC AUC: 0.803 vs. 0.658; NRI: 0.220 vs. BCLC 0.446).

Conclusions:

• Refinement of HCC resectability criteria using AFP and DCP identifies a biologically aggressive subset within the initially resectable group.
• This refined approach shows potential for improving the prediction of early recurrence in HCC patients.
• Further validation is warranted to integrate these biological markers into clinical decision-making for HCC management.