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Prognostic value of expanded liver transplantation criteria—the 5‐5‐500 rule—in patients with hepatic resection for intermediate‐stage hepatocellular carcinoma
Author(s) -
Shinkawa Hiroji,
Tanaka Shogo,
Takemura Shigekazu,
Amano Ryosuke,
Kimura Kenjiro,
Kinoshita Masahiko,
Miyazaki Toru,
Kubo Shoji
Publication year - 2020
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.792
Subject(s) - hepatocellular carcinoma , medicine , cirrhosis , liver cancer , liver transplantation , stage (stratigraphy) , gastroenterology , transplantation , biology , paleontology
Background This study aimed to evaluate the prognostic impact of the 5‐5‐500 rule in patients after hepatic resection for the intermediate stage of hepatocellular carcinoma (HCC; The Barcelona Clinic Liver Cancer classification [BCLC] B). Methods 177 patients had hepatic resection for BCLC‐B HCC. The 5‐5‐500 rule was defined by tumor size ≤5 cm in diameter, tumor number ≤5, and α‐fetoprotein ≤500 ng/mL. Results The 3‐, 5‐, and 7‐year recurrence‐free survival rates were 22%, 14%, and 11% in patients within the 5‐5‐500 rule, and 16%, 10%, and 10% in patients beyond the 5‐5‐500 rule, respectively ( P = .015). The 3‐, 5‐, and 7‐year overall survival rates were 72%, 47%, and 34% in patients within the 5‐5‐500 rule, and 52%, 31%, and 25% in patients beyond the 5‐5‐500 rule, respectively ( P = .035). Being beyond the 5‐5‐500 rule and liver cirrhosis were independent prognostic factors for recurrence‐free survival. For overall survival, being beyond the 5‐5‐500 rule, age ≥65 years, Child–Pugh class B, and anti‐hepatitis C antibody positive were identified as independent prognostic factors. Conclusions The 5‐5‐500 rule could predict prognosis in BCLC‐B patients with hepatic resection. Hepatic resection might provide survival benefit for selected patients with BCLC‐B HCC within the 5‐5‐500 rule.