Clinical utility of the novel oncological criteria of resectability for advanced hepatocellular carcinoma

Introduction: Introduction of new systemic therapies for hepatocellular carcinoma (HCC) has led to the development of new oncological criteria of resectability for the resectability of HCC. This study was aimed at validating the prognosticating ability and clinical utility of the resectability classification based on the novel criteria in real world clinical practice. Methods: This study was conducted in 1,822 patients who had undergone curative resection for HCC (Population 1) and 107 patients with unresectable disease who had received lenvatinib therapy (Population 2). Patients were classified into three groups according to the novel oncological criteria for resectability (R, resectable; BR1, borderline resectable 1; and BR2, borderline resectable 2) and the prognosticating ability and clinical utility of this classification based on the novel criteria were examined. Results: Multivariate analysis confirmed that classification of the patients according to the oncological resectability criteria was significantly correlated with the overall survival (BR1: hazard ratio [HR], 1.88; 95% CI, 1.38-2.55; BR2: HR, 4.12; 95% CI, 3.01-5.65) and recurrence-free survival (BR1: HR, 1.86; 95% CI, 1.44-2.41; BR2: HR, 3.62; 95% CI, 2.71-4.82) in Population 1. In Population2, the resectability classification was correlated with the rates of successful additional intervention (surgery, transarterial chemoembolization, or radiotherapy) (BR1 65.7% vs. BR2 42.3%, P = 0.023) and curative-intent conversion surgery (BR1 17.1% vs. BR2 4.2%, P = 0.056) after lenvatinib therapy, and was also predictive of the overall survival (HR, 1.96; 95% CI, 1.13-3.38 for BR2 [vs. BR1]) and time-to-treatment failure (HR, 1.81; 95% CI, 1.04-3.17 for BR2 [vs. BR1]). Conclusion: The resectaility classification based on the noverl oncological criteria for resectability showed acceptable prognosticating ability in both surgically and medically treated populations with advanced HCC.