“Three-Grade Criteria” of radical resection for primary liver cancer

Objective The present study was designed to develop the “Three-Grade Criteria” for radical resection of primary liver cancer (PLC) and to evaluate its clinical significance. Methods Criteria for radical resection of PLC were summed up to 3 grades based on criterion development. Grade I: complete removal of all gross tumors with no residual tumor at the excision margin. Grade II: on the basis of Grade I, additional 4 requirements were added: (1) the tumor was not more than two in number; (2) no tumor thrombi in the main trunks or the primary branches of the portal vein, the common hepatic duct or its primary branches, the hepatic veins or the inferior vena cava; (3) no hilar lymph nodes metastases; (4) no extrahepatic metastases. Grade III: in addition to the above criteria, negative postoperative follow-up result including AFP dropping to a normal level (with positive AFP before surgery) within 2 months after operation, and no residual tumor upon diagnostic imaging.The clinical data from 354 patients with PLC who underwent hepatectomy were reviewed retrospectively. Based on the “Three-Grade Criteria” these patients were divided into 6 groups: Grade I radical group, Grade I palliative group, Grade II radical group, Grade II palliative group, Grade III radical group, Grade III palliative group. The survival rate of each group was calculated by the life-table method and the rates compared among the groups. Results The survival rate of patients receiving radical treatment was better than those receiving palliative treatment ( P <0.01). Survival improved as more criteria were applied. The 5-year survival rate of the patients in Grade I, II and III who underwent radical resection was 43.2%, 51.2% and 64.4%, respectively ( P <0.01). Conclusion The “Three-Grade Criteria” may be applied for judging the curability of resection therapy for PLC. The stricter the criterion used, the better the survival would be. Adopting high-grade criteria to select cases and guide operations and strengthening postoperative follow-up would improve the results of hepatectomy for PLC.