Treatment outcomes of hepatectomy and systemic chemotherapy based on oncological resectability criteria for hepatocellular carcinoma.

Aim: The oncological resectability criteria for hepatocellular carcinoma (HCC) have recently been established (R/BR1/BR2), and validating the outcomes is an urgent issue. This study aimed to analyze the outcomes of hepatectomy and systemic chemotherapy based on the oncological resectability criteria.

Methods: A total of 931 patients in the hepatectomy group and 273 in the systemic chemotherapy group who received atezolizumab/bevacizumab, lenvatinib, or durvalumab plus tremelimumab were recruited.

Results: The median survival times (MST) in the hepatectomy group were R, 107.2 mo; BR1, 44.4 mo; and BR2, 18.4 mo ( < 0.0001). The MSTs in the systemic chemotherapy group were R, 16.3 mo; BR1, 24.5 mo; and BR2, 16.1 mo ( = 0.3598). A comparison of survival of patients in the BR2 category revealed no significant difference between the two groups for those with modified albumin-bilirubin grade 1 + 2a ( = 0.7343) and grade 2b + 3 ( = 0.6589). The BR2 definition comprised three tumor factors, and the MST of patients with only one BR2-defining factor tended to be better in the hepatectomy group than in the systemic chemotherapy group (22.9 vs 20.2 mo,  = 0.0977). Meanwhile, the MST tended to be better in the systemic chemotherapy group than in the hepatectomy group (16.5 vs 12.6 mo) for those with two to three BR2-defining factors, although the difference was insignificant ( = 0.4252).

Conclusion: The oncological resectability criteria for HCC effectively stratified the prognosis after hepatectomy. Treatment outcomes of hepatectomy in patients with two to three BR2-defining factors are limited, suggesting the need for multidisciplinary treatment.