AUTHOR=Bai Tingting , Wang Enxin , Zhao Shoujie , Han Dandan , Zhao Yan , Chen Hui , Zhu Jun , Han Tenghui , Bai Yang , Lou Yanju , Zhang Yongchao , Yang Man , Zuo Luo , Fan Jiahao , Chen Xing , Jia Jia , Wu Wenbin , Ren Weirong , Zhu Yejing , Ma Shouzheng , Xu Fenghua , Tang Yuxin , Du Xilin , Zhao Junlong , Li Jing , Qi Xingshun , Han Ying , Chen Dongfeng , Liu Lei 

TITLE=Potential candidates for liver resection in liver-confined advanced HCC: a Chinese multicenter observational study

JOURNAL=Frontiers in Oncology

VOLUME=Volume 13 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2023.1170923

DOI=10.3389/fonc.2023.1170923

ISSN=2234-943X

ABSTRACT=Background: Advanced hepatocellular carcinoma (HCC) is characterized as symptomatic tumors [performance status (PS) score of 1-2], vascular invasion and extrahepatic spread, but patients with PS1 alone may be eliminated from this stage. Although liver resection is used for liver-confined HCC, its role in patients with PS1 alone remains controversial. Therefore, we aimed to explore its application in such patients and identify potential candidates. 
Methods: Eligible liver-confined HCC patients undergoing liver resection were retrospectively screened in 15 Chinese tertiary hospitals, with limited tumor burden, liver function and PS scores. Cox-regression survival analysis was used to investigate the prognostic factors and develop a risk-scoring system, according to which patients were substratified using fitting curves and the predictive values of PS were explored in each stratification. 
Results: From January 2010 to October 2021, 1535 consecutive patients were selected. In the whole cohort, PS, AFP, tumor size and albumin were correlated with survival (adjusted P<0.05), based on which risk scores of every patient were calculated and ranged from 0 to 18. Fitting curve analysis demonstrated that the prognostic abilities of PS varied with risk scores and that the patients should be divided into three risk stratifications. Importantly, in the low-risk stratification, PS lost its prognostic value, and patients with PS1 alone achieved a satisfactory 5-year survival rate of 78.0%, which was comparable with that od PS0 patients (84.6%).
Conclusions: Selected patients with PS1 alone and an ideal baseline condition may benefit from liver resection and may migrate forward to BCLC stage A.