Survival Outcomes After Liver Resection for Barcelona Clinic Liver Cancer Stage B Hepatocellular Carcinoma Have Improved in the Contemporary Era

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AIM: The role of liver resection for Barcelona Clinic Liver Cancer stage B (BCLC-B) hepatocellular carcinoma (HCC) remains debated. Advances in imaging and multidisciplinary therapy have improved outcomes in contemporary practice, in our institution over time. We evaluated era-specific changes in survival after liver resection for BCLC-B HCC and shifts in postrecurrence management. METHODS: This single-center retrospective cohort analyzed consecutive patients undergoing curative liver resection for BCLC-A and BCLC-B disease (n = 418 and 113) between 2005 and 2021. An exploratory minimum p-value approach based on 5-year overall survival (OS) in BCLC-B cases was used to determine a candidate cutoff for era stratification. Patients were divided into early and modern eras; survival outcomes were compared using propensity score matching. RESULTS: The 5-year OS of BCLC-B patients improved from 44% before 2014 to 74% after 2015 (p < 0.05), whereas 5-year disease-free survival (DFS) increased from 5% to 22% (p < 0.05). Postrecurrence management shifted toward greater use of radiofrequency ablation/percutaneous ethanol injection therapy and systemic therapy with tyrosine kinase inhibitors or immune checkpoint inhibitors, with a relative decline in transarterial chemoembolization. In the contemporary era, 5-year OS of BCLC-B approximated that of BCLC-A (74% vs. 72%, p = 0.97), though DFS remained lower (22% vs. 45%, p < 0.05). Even after propensity score matching, the improvement in OS and DFS after 2015 remained significant (p < 0.05). CONCLUSIONS: Survival after liver resection for BCLC-B HCC has improved substantially in the modern era, achieving 5-year OS comparable to BCLC-A. Resection should be considered for appropriately selected BCLC-B patients within advanced multidisciplinary care.

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