Surgical resection improves long-term survival of patients with hepatocellular carcinoma across different Barcelona Clinic Liver Cancer stages

Figures & data

Figure 1 Study flowchart and inclusion of participants.

Abbreviations: BCLC, Barcelona Clinic Liver Cancer; BSC, best supportive care; HCC, hepatocellular carcinoma; LRT, locoregional therapy; RFA, radiofrequency ablation; SR, surgical resection.

Table 1 Characteristics of the patients with hepatocellular carcinoma enrolled according to different BCLC stages

Variables	Total (N=1443)	BCLC stage 0-A (n=330)	BCLC stage B (n=798)	BCLC stage C (n=315)
Male gender	1170 (81.1%)	265 (80.3%)	644 (80.7%)	261 (82.9%)
Age (years)	55 (7–88)	54 (24–82)	55 (13–88)	53 (7–87)
History of cigarette smoking*	652 (45.2%)	138 (41.8%)	347 (43.5%)	167 (53.0%)
History of alcohol abuse*	499 (34.6%)	98 (29.7%)	271 (34.0%)	130 (41.3%)
Regular HCC screening**	745 (51.6%)	200 (60.6%)	382 (47.9%)	163 (51.7%)
Diabetes	119 (8.2%)	31 (9.4%)	61 (7.6%)	27 (8.6%)
HBV positivity	1046 (72.2%)	252 (76.4%)	547 (68.5%)	247 (78.4%)
HCV positivity	76 (5.3%)	26 (7.9%)	37 (4.6%)	13 (4.1%)
Liver cirrhosis**	957 (66.3%)	242 (73.3%)	488 (61.1%)	227 (72.1%)
Child–Pugh class B**	470 (32.6%)	65 (19.7%)	279 (35.0%)	126 (40.0%)
AFP >200 ng/mL*	802 (55.6%)	146 (44.2%)	439 (55.0%)	217 (68.9%)
Maximal diameter ≥5 cm**	666 (46.2%)	0	463 (58.0%)	204 (64.8%)
Three or more tumor nodules**	190 (13.2%)	0	142 (17.8%)	48 (15.2%)
Primary treatments*, **
SR	422 (29.2%)	116 (35.2%)	239 (29.9%)	67 (21.3%)
LRTa	667 (46.2%)	91 (51.8%)	357 (44.7%)	139 (44.1%)
Best supportive care	354 (24.5%)	43 (13.0%)	202 (25.3%)	109 (34.6%)
30-day mortality*, **	66 (4.6%)	11 (3.3%)	34 (4.3%)	21 (6.7%)
90-day mortality*, **	143 (9.9%)	19 (5.8%)	75 (9.4%)	49 (15.6%)
Median survival time (months)*, **	33 (0–100)	43 (0–100)	32 (0–100)	27 (0–90)

Notes:

* p<0.05 when compared between BCLC 0-A and BCLC C groups;

** p<0.05 when compared between BCLC 0-A and BCLC B groups.

a Eighty patients of BCLC stage 0-A receiving radiofrequency ablation were excluded.

Abbreviations: AFP, alpha-fetoprotein; BCLC, Barcelona Clinic Liver Cancer; BSC, best supportive care; HBV, hepatitis B virus; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; LRT, locoregional therapy; SR, surgical resection.

Figure 2 Kaplan–Meier survival curves of patients in different BCLC stages.

Abbreviation: BCLC, Barcelona Clinic Liver Cancer.

Figure 3 Overall survival of patients within BCLC stage 0-A HCC following different treatments.

Abbreviations: BCLC, Barcelona Clinic Liver Cancer; BSC, best supportive care; HCC, hepatocellular carcinoma; TACE, transcatheter arterial chemoembolization.

Table 2 Characteristics of SR and LRT groups within BCLC stage B before and after PSM analysis

Variables	Before PSM			After PSM
	SR (n=239)	LRT (n=357)	p-value	SR (n=238)	LRT (n=238)	p-value
Male gender	196 (82.0%)	289 (81.0%)	0.746	43 (18.1%)	49 (20.6%)	0.486
Age (years)	53 (13–78)	55 (17–88)	0.022	54 (13–78)	55 (17–88)	0.102
Smoking	108 (45.2%)	152 (42.6%)	0.529	107 (45.0%)	101 (42.4%)	0.579
Alcohol abuse	89 (37.2%)	117 (32.8%)	0.292	88 (37.0%)	77 (32.4%)	0.289
Diabetes	17 (7.1%)	25 (7.0%)	1.000	17 (7.1%)	16 (6.7%)	1.000
HBV positivity	179 (74.9%)	252 (70.6%)	0.249	177 (74.4%)	167 (70.2%)	0.305
HCV positivity	9 (3.8%)	17 (4.8%)	0.560	9 (3.8%)	12 (5.0%)	0.503
Liver cirrhosis	167 (69.9%)	272 (76.2%)	0.086	166 (69.7%)	167 (70.2%)	1.000
Child–Pugh class B	16 (6.7%)	43 (12.0%)	0.032	15 (6.3%)	15 (6.3%)	1.000
AFP >200 ng/mL	138 (57.7%)	196 (54.9%)	0.494	75 (31.5%)	86 (36.1%)	0.286
Maximal diameter >5 cm	150 (62.8%)	206 (57.7%)	0.217	149 (62.6%)	149 (62.6%)	1.000
Three or more tumor nodules	35 (14.6%)	73 (20.4%)	0.071	34 (14.3%)	34 (14.3%)	1.000
Bilobar disease	26 (10.9%)	61 (17.1%)	0.035	26 (10.9%)	26 (10.9%)	1.000
Median survival time (months)	45 (0–100)	36 (0–100)	<0.001	45 (0–100)	36 (0–96)	0.002

Abbreviations: AFP, alpha-fetoprotein; BCLC, Barcelona Clinic Liver Cancer; HBV, hepatitis B virus; HCV, hepatitis C virus; LRT, locoregional therapy; PSM, propensity score matching; SR, surgical resection.

Figure 4 Overall survival of patients in BCLC stage B after different treatments in unadjusted (A) and adjusted (B) cohorts.

Abbreviations: BCLC, Barcelona Clinic Liver Cancer; BSC, best supportive care; LRT, locoregional therapy.

Table 3 Characteristics of patients with BCLC stage C undergoing SR and LRT after PSM analysis

Variables	Before PSM			After PSM
	SR (n=67)	LRT (n=131)	p-value	SR (n=53)	LRT (n=53)	p-value
Male gender	53 (79.1%)	108 (82.4%)	0.569	42 (79.2%)	46 (86.8%)	0.458
Age (years)	50.5 (21–83)	53 (7–87)	0.202	51 (21–83)	52 (30–87)	0.355
Smoking	37 (55.2%)	70 (53.4%)	0.811	31 (58.5%)	26 (49.1%)	0.330
Alcohol abuse	30 (44.8%)	50 (38.2%)	0.370	24 (45.3%)	18 (34.0%)	0.233
Diabetes	6 (9.0%)	9 (6.9%)	0.632	6 (11.3%)	2 (3.8%)	0.270
HBV positivity	54 (80.6%)	102 (77.9%)	0.656	40 (75.5%)	36 (67.9%)	0.388
HCV positivity	2 (3.0%)	7 (5.3%)	0.451	2 (3.8%)	2 (3.8%)	1.000
Liver cirrhosis	47 (70.1%)	96 (73.3%)	0.641	34 (64.2%)	28 (52.8%)	0.331
Child–Pugh class B	5 (7.5%)	24 (18.3%)	0.041	5 (9.4%)	4 (7.5%)	1.000
AFP >200 ng/mL	48 (71.6%)	95 (72.5%)	0.896	38 (71.7%)	38 (71.7%)	1.000
Maximal diameter >5 cm	34 (50.7%)	91 (69.5%)	0.010	33 (62.3%)	31 (58.5%)	0.845
Three or more tumor nodules	4 (6.0%)	21 (16.0%)	0.045	4 (7.5%)	9 (17.0%)	0.236
Bilobar disease	1 (1.5%)	18 (13.7%)	0.004	1 (1.9%)	0	1.000
Macrovascular invasion	52 (77.6%)	110 (84.0%)	0.272	45 (84.9%)	44 (83.0%)	1.000
Median survival time (months)	42 (1–90)	24.5 (0–78)	<0.001	39 (3–90)	27 (1–78)	0.003

Abbreviations: AFP, alpha-fetoprotein; BCLC, Barcelona Clinic Liver Cancer; HBV, hepatitis B virus; HCV, hepatitis C virus; LRT, locoregional therapy; PSM, propensity score matching; SR, surgical resection.

Figure 5 Overall survival of patients in BCLC stage C after different treatments in unadjusted (A) and adjusted (B) cohorts.

Abbreviations: BCLC, Barcelona Clinic Liver Cancer; BSC, best supportive care; LRT, locoregional therapy.