Introduction: Optimal treatment of hepatocellular carcinoma (HCC) beyond the Milan criteria is in debate. We aimed to identify candidates for surgical resection (SR) in Barcelona Clinic Liver Cancer (BCLC) –A/B HCC beyond the Milan criteria with survival benefit. Methods: Patients with BCLC-A/B HCC beyond the Milan criteria at the National Taiwan University Hospital during 2005 and 2019 were screened and those who received transarterial chemoembolization (TACE) or SR were consecutively included. The tumor burden was classified by the seven-eleven criteria into low (≤7), intermediate (7-11) or high (>11). Multivariable cox proportional hazard regression analysis was used for outcome prediction. Results: Overall, 474 patients who received SR (n=247), and TACE (n=227) were enrolled. Patients underwent SR were significantly younger with better liver reserve. There were 76 (31%), and 129 (57%) deaths in the SR and TACE groups after a median follow-up of 3.9 and 2.1 years, respectively. The seven-eleven criteria could distinguish median overall survival (OS) among low (n=149), intermediate (n=203), and high (n=122) tumor burden groups (7.7 vs. 6.9 vs. 2.8 years, respectively, P < 0.001). Patients receiving SR had a significantly higher median OS compared with TACE in those with intermediate (8.2 vs. 2.6 years, P < 0.001) and high (5.6 vs. 1.5 years, P = 0.001) tumor burden. After adjustment for age, sex, and liver reserve, SR was predictive for better OS in intermediate (adjusted hazard ratio [aHR]: 0.45, 95% CI: 0.27-0.75) and high tumor burden groups (aHR: 0.54, 95% CI: 0.32-0.92). The survival benefit of SR especially confines to patients within 3 tumors. Conclusions: In patients with BCLC-A/B HCC beyond the Milan criteria with tumor burden beyond the up-to-7 criteria but within 3 tumors, SR has better OS than TACE and should be considered in resectable patients.


中文翻译：

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超过米兰标准的巴塞罗那临床肝癌 A/B 期肝细胞癌中 7-11 标准手术切除优化生存获益

简介： 超出米兰标准的肝细胞癌 (HCC) 的最佳治疗方案存在争议。我们的目的是确定巴塞罗那临床肝癌 (BCLC) 手术切除 (SR) 的候选者 - A/B HCC 超出米兰标准且具有生存获益。方法：筛选2005年至2019年期间在台大医院接受过经动脉化疗栓塞（TACE）或SR治疗的超过米兰标准的BCLC-A/B HCC患者。根据7-11标准将肿瘤负荷分为低（≤7）、中（7-11）或高（>11）。多变量 cox 比例风险回归分析用于结果预测。结果：总共有 474 名接受 SR (n=247) 和 TACE (n=227) 的患者入选。接受 SR 治疗的患者明显更年轻，肝脏储备更好。中位随访 3.9 年和 2.1 年后，SR 组和 TACE 组分别有 76 例 (31%) 和 129 例 (57%) 死亡。7-11 标准可以区分低 (n=149)、中等 (n=203) 和高 (n=122) 肿瘤负荷组的中位总生存期 (OS)（分别为 7.7 年、6.9 年和 2.8 年， P < 0.001）。在中度（8.2 年与 2.6 年，P < 0.001）和高（5.6 年与 1.5 年，P = 0.001）肿瘤负荷的患者中，接受 SR 的患者的中位 OS 显着高于 TACE。调整年龄、性别和肝脏储备后，SR 可预测中间（调整后风险比 [aHR]：0.45，95% CI：0.27-0.75）和高肿瘤负荷组（aHR：0.54，95% CI）的 OS 更好：0.32-0.92）。SR 的生存获益尤其局限于 3 个肿瘤以内的患者。结论：对于超出米兰标准且肿瘤负荷超过 up-to-7 标准但在 3 个肿瘤以内的 BCLC-A/B HCC 患者，SR 的 OS 优于 TACE，可切除患者应考虑。