title: Surgical resection for advanced hepatocellular carcinoma according to Barcelona Clinic Liver Cancer (BCLC) staging.
abstract: OBJECTIVE
  The BCLC staging classification has been widely endorsed to predict the prognosis of patients with HCC. However, its validity as a means of therapeutic instructions needs to be challenged. This study aimed to evaluate perioperative and long-term outcomes of surgical resection in patients with advanced hepatocellular carcinoma (HCC) according to the Barcelona Clinic Liver Cancer (BCLC) staging.
  
  
  METHODS
  This study used a prospectively maintained database consisting of a consecutive series of 511 Chinese patients with advanced HCC who underwent surgical resection in a hepatobiliary surgical center from 2001 to 2007. Mortality, morbidity, long-term overall survival (OS) and disease-free survival (DFS) were evaluated.
  
  
  RESULTS
  Hospital mortality was 2.3%, and overall morbidity was 31.3%. After a median follow-up period of 27.8 months (range, 0-112 months), the 1-, 3- and 5-year OS rate was 69.9, 41.2 and 30.5%, and the 1-, 3- and 5-year DFS rate was 48.2, 30.3 and 24.0%, respectively. The 1-, 3- and 5-year OS and DFS rates were significantly poorer in patients with vascular invasion and/or extrahepatic spread than those in patients without (both P < 0.001), and also poorer in patients with biliary invasion than those in patients without (both P < 0.05).
  
  
  CONCLUSIONS
  Surgical resection could be considered in part of patients with advanced HCC (BCLC stage C), with low mortality, acceptable morbidity and favorable survival benefits. These results imply that BCLC recommendations for treatment schedules of advanced HCC need to be re-evaluated.
authors.affiliation: Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, Shanghai 200438, China.
authors.forename: Tian
authors.initials: T
authors.lastname: Yang
authors.forename: Chuan
authors.initials: C
authors.lastname: Lin
authors.forename: Jian
authors.initials: J
authors.lastname: Zhai
authors.forename: Song
authors.initials: S
authors.lastname: Shi
authors.forename: Min
authors.initials: M
authors.lastname: Zhu
authors.forename: Nan
authors.initials: N
authors.lastname: Zhu
authors.forename: Jun-Hua
authors.initials: JH
authors.lastname: Lu
authors.forename: Guang-Shun
authors.initials: GS
authors.lastname: Yang
authors.forename: Meng-Chao
authors.initials: MC
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002648:Child; D016208:Databases, Factual; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate