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• W1997952103 abstract "As the sixth most common cancer and the third leading cause of cancer-related deaths worldwide, hepatocellular carcinoma (HCC) imposes a significant burden on health care [1]. The geographical distribution of HCC is extremely uneven. Despite the increased frequency of surveillance programs, the majority of patients have an intermediate or advanced stage HCC at diagnosis due to no significant symptoms in early stage. Of these, quite a number of them are with multinodular HCC (≥2). It is therefore vital to choose the most effective and appropriate therapy for these patients. Hepatic resection (HR) is the standard therapy for early stage HCC in non-cirrhotics with a well-preserved liver function [2]. However, the role of HR in the treatment of multinodular HCC remains controversial. According to the widely used Barcelona Clinic liver cancer (BCLC) staging system [3] and its updated review [4], HR should not be recommended to the patients with multinodular HCC [3]. Although the recommendations of BCLC staging system are endorsed by the American Association for the Study of Liver Diseases (AASLD) [5] and the European Association for the Study of the Liver (EASL) [6], many large and qualified liver centers in treating HCC especially those in Asia do not subscribe to these guidelines. Some retrospective studies have demonstrated that HR is superior to palliative treatments for multinodular HCC [7–10]. Although these retrospective studies may have some unintentional selection bias, the first randomized controlled trial (RCT) by Yin and coworkers definitely support this conclusion [11]. These studies highlight one of the ongoing controversies that surround the BCLC system. The fact that AASLD/EASL guidelines do not recommend HR for patients with intermediate or advanced stage HCC reflects primarily concerns over high recurrence and perioperative mortality, rather than direct prospective clinical evidence. However, recent advances in perioperative management and surgical techniques, as well as more restrictive selection of patients for HR, have rapidly reduced perioperative mortality, which was only 1.1 % in the RCT [11]. Moreover, HR can achieve satisfactory overall survival [12] in patients with recurrent HCC. Aggressive treatment of recurrence by repeat HR, radiofrequency ablation (RFA), and adjuvant therapies, such as transarterial chemoembolization (TACE), can offer satisfactory overall survival (OS) [13–15]. Therefore, this trial and other retrospective studies concluding HR superior to TACE makes sense [7–9, 11]. RCTs directly comparing TACE and HR in such patients have been lacking because clinicians are loathe to treat them exclusively with TACE, given the demonstrated survival benefit of HR inmany retrospective studies [7–9]. For this reason, this RCT [11] stands out as providing clear, direct evidence against current guidelines. Therefore, it is a very valuable study. This RCT was conducted on 173 patients with multinodular HCC outside of Milan criteria who were treated in a big liver center in eastern China. The patients were included in a short time period from 2008 to 2010 and underwent intention-to-treat analysis. Most of the included patients (91.3 %) were positive for hepatitis B surface antigen and with cirrhosis (82.7 %). There were no significant differences in the 30-day and in the 90-day mortality between the Jian-Hong Zhong and Fei-Xiang Wu contributed equally to this work. J.<H. Zhong (*) : F.<X. Wu Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, He Di Rd. #71, Nanning 530021, People’s Republic of China e-mail: zhongjianhong66@163.com" @default.
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• W1997952103 date "2014-09-01" @default.
• W1997952103 modified "2023-09-26" @default.
• W1997952103 title "Hepatic resection associated with good survival for selected patients with multinodular hepatocellular carcinoma" @default.
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• W1997952103 doi "https://doi.org/10.1007/s13277-014-2571-z" @default.
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