Multiplication of tumor maximum diameter and number as a new surgical indicator for BCLC intermediate-stage hepatocellular carcinoma.

AIM: Recent advances in treatment modalities have been made, limiting the indication of hepatic resection in the treatment strategy for HCC patients. This retrospective study investigated the significance of multiplication of tumor maximum diameter and number (MDN) as a surgical indicator for BCLC intermediate-stage HCC.

METHODS: Forty-nine patients with BCLC intermediate-stage HCC who underwent curative hepatic resection between 2000 and 2020 were enrolled in this study. Prognostic factors of overall survival (OS) and disease-free survival (DFS) including the product of MDN were analyzed.

RESULTS: Patients with MDN >12 experienced significantly worse prognosis compared with those with MDN ≤12 (p=0.0395), and 5-year OS rates after hepatic resection were 60.0% and 23.4%, respectively. Moreover, the DFS rate of patients with MDN >12 was significantly worse compared with those with MDN ≤12 (p=0.0049), and all patients with MDN >12 experienced recurrence within 3 years after hepatic resection. In the multivariate analysis, MDN >12 was identified as the only independent prognostic factor of both OS and DFS. In addition, patients with MDN >12 suffered from uncontrollable recurrence by locoregional treatment, such as more than four intrahepatic and extrahepatic recurrences, after hepatic resection.

CONCLUSIONS: MDN index might be a new surgical indicator for BCLC intermediate-stage HCC and influence clinical decision-making for individual treatment strategies. This article is protected by copyright. All rights reserved.