title: Survival benefit of liver resection for patients with hepatocellular carcinoma across different Barcelona Clinic Liver Cancer stages: a multicentre study.
abstract: OBJECTIVE
  The role of hepatic resection for hepatocellular carcinoma (HCC) in different Barcelona Clinic Liver Cancer (BCLC) stages is controversial. We aimed at measuring the survival benefit of resection vs. non-surgical-therapies in each BCLC stage.
  
  
  METHODS
  Using the ITA.LI.CA database, we identified 2090 BCLC A, B, and C HCC patients observed between 2000 and 2012: 550 underwent resection, 1046 loco-regional therapy (LRT), and 494 best supportive care (BSC). A multivariate log-logistic model was chosen to predict median survival (MS) after resection vs. MS after LRT or BSC. The results were expressed as net survival benefit of resection: (MS resection-MS LRT)/MS BSC.
  
  
  RESULTS
  After stratifying for BCLC stage, the median net survival benefit of resection over LRT was: BCLC 0=62% (40%, 82%), A=45% (13%, 65%), B=46% (9%, 76%), C=-16% (-55%, 33%). Model for end-stage liver disease (MELD) score>9, Child B class, and performance status (PST)=2 were the main risk factors for liver resection. 1181 Child A patients (57%) with MELD⩽9 and PST<2 had always a large positive net survival benefit of resection over LRT, independently of BCLC stage: BCLC 0=64% (44%, 85%), A=59% (45%, 74%), B=71% (52%, 90%), C=56% (36%, 78%). Among the 909 (43%) patients with at least one risk factor (MELD>9 or PST=2 or Child B class), resection did not prove any survival benefit over LRT.
  
  
  CONCLUSIONS
  Resection could result in survival benefit over LRT for HCC patients regardless of their BCLC stage, provided that liver dysfunction (Child B or MELD>9) and PST>1 are absent.
authors.affiliation: Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vitale
authors.affiliation: Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy. Electronic address: burra@unipd.it.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Burra
authors.affiliation: Biostatistics Unit, University of Padua, Padua, Italy.
authors.forename: Anna Chiara
authors.initials: AC
authors.lastname: Frigo
authors.affiliation: Department of Medical and Surgical Sciences, Division of Semeiotics, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Trevisani
authors.affiliation: Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Farinati
authors.affiliation: Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
authors.forename: Gaya
authors.initials: G
authors.lastname: Spolverato
authors.affiliation: Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Volk
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, University of Genova, Genova, Italy.
authors.forename: Edoardo G
authors.initials: EG
authors.lastname: Giannini
authors.affiliation: Division of Surgery, San Marco Hospital, Zingonia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ciccarese
authors.affiliation: Department of Gastroenterology and Internal Medicine, Division of Internal Medicine, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Piscaglia
authors.affiliation: Division of Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Gian Lodovico
authors.initials: GL
authors.lastname: Rapaccini
authors.affiliation: Division of Medicine, Bolognini Hospital, Seriate, Italy.
authors.forename: Mariella
authors.initials: M
authors.lastname: Di Marco
authors.affiliation: Division of Gastroenterology, Belcolle Hospital, Viterbo, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Caturelli
authors.affiliation: Department of Gastroenterology and Internal Medicine, Division of Internal Medicine, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Zoli
authors.affiliation: Department of Medicine, Division of Radiology, Fatebenefratelli Hospital, Milan, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Borzio
authors.affiliation: Biomedical Department of Internal and Specialistic Medicine, Division of Gastroenterology, University of Palermo, Palermo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cabibbo
authors.affiliation: Bolzano Regional Hospital, Division of Gastroenterology, Bolzano, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Felder
authors.affiliation: Division of Internal Medicine and Gastroenterology, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasbarrini
authors.affiliation: Division of Gastroenterology and Metabolic Diseases, University Hospital of Pisa, Pisa, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Sacco
authors.affiliation: Department of Internal Medicine, Ospedale per gli Infermi di Faenza, Faenza, Italy.
authors.forename: Francesco Giuseppe
authors.initials: FG
authors.lastname: Foschi
authors.affiliation: Division of Infectious Diseases and Hepatology, University Hospital of Parma, Parma, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Missale
authors.affiliation: Department of Medicine and Surgery, Division of Gastroenterology, University of Naples, "Federico II", Naples, Italy.
authors.forename: Filomena
authors.initials: F
authors.lastname: Morisco
authors.affiliation: Division of Gastroenterology, Polytechnic University of Marche, Ancona, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Svegliati Baroni
authors.affiliation: Biomedical Department of Internal and Specialistic Medicine, Division of Internal Medicine 2, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Virdone
authors.affiliation: Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging / Q000379:methods; D011379:Prognosis; D016896:Treatment Outcome
keywords: Best supportive care; Cirrhosis; Hepatocellular carcinoma; Liver resection; Loco-regional therapies; Survival benefit