Chronological evolution in liver resection for hepatocellular carcinoma: Prognostic trends across three decades in early to advanced stages

Background: While liver resection remains the best curative option for hepatocellular carcinoma (HCC), it is unclear whether the consistent progress of multidisciplinary approaches in managing HCC over several decades has influenced the outcomes of liver resection.

Methods: Patients undergoing liver resection for HCC from 1993 to 2022 in our institution were retrospectively assessed and stratified into three periods according to the year of liver resection, P1 (1993-2000), P2 (2001-2009), and P3 (2010-2022), and tumor status using the Barcelona Clinic Liver Cancer (BCLC) staging system.

Results: A total of 1257 patients were included (P1:P2:P3 = 385:490:382, BCLC stage 0/A:B:C = 908:214:135). In the entire cohort, long-term surgical outcomes significantly improved across the three periods. In BCLC stage 0/A HCC, the 5-year overall survival (OS) rate improved from P1 to P3 (P1: 65.5 %, P2: 71.3 %, P3: 80.4 %), with HRs of 0.655 (95 % CI: 0.536 to 0.800) and 0.595 (95 % CI: 0.455 to 0.778) for P2 vs. P1 and P3 vs. P1, respectively. Conversely, limited advancements were observed in patients with BCLC stage B or C HCC. Multivariate analysis in BCLC stage 0/A patients demonstrated that ICGR15 > 15 %, ALBI grade 2 or 3 (vs. 1), multiple tumors, microvascular invasion, and surgical period (P2 vs.P1) remained independent poor prognostic factors for OS.

Conclusions: Substantial advancements in the long-term outcomes for HCC patients undergoing liver resection, particularly in BCLC stage 0/A, were observed, while minimal improvement was noted for BCLC stage B and C.