Dados do Trabalho

Título

Liver resection for hepatocellular carcinoma beyond the BCLC: are multinodular disease, portal hypertension, and portal system invasion really contraindications?

Resumo

Background and objectives: Evaluate results of hepatocellular carcinoma resection in a single center, with a more liberal indication for resection than proposed by the Barcelona Clínic Liver Cancer guideline.
Methods: From a retrospective cohort of 150 patients who underwent hepatocellular carcinoma resection, results were evaluated and compared facing both 2010 and 2018 BCLC versions. Overall and disease-free survival after resection in patients with none, 1, 2, or 3 risk factors as proposed by the BCLC as contraindications to resection (portal hypertension, portal invasion, and more than one nodule) were evaluated.
Results: Nodule size and the presence of portal invasion alone, did not impact prognosis. If BCLC 2010 and 2018 recommendations had been followed, 46.7% and 26.7% of patients, respectively, would not have received a potentially curative treatment. Median overall and disease-free survival for patients with one BCLC contraindication factor was 43.3 and 15.1 months, respectively. The presence of two risk factors had a negative impact on OS and DFS, although some patients presented long-term survival. The only patient with three risk factors presented a poor outcome.
Conclusions: Selected patients with one BCLC contraindication factor, among portal hypertension, portal system invasion and more than one nodule, may undergo resection with good results, whereas those with two factors only in favorable scenarios. Patients with three risk factors do not appear to benefit from resection.