Tumor Number and Model for End-Stage Liver Disease Score as Selection Criteria for Resection or Embolization of Intermediate-Stage Hepatocellular Carcinoma.

BACKGROUND: Tumor and liver-related factors are well-known prognostic factors for patients with hepatocellular carcinoma (HCC). The Japanese Society of Hepatology (JSH) guidelines recommend considering liver resection (LR) for patients with multiple tumors and a tumor number ≤ 3. A previous Italian study showed that a model for end-stage liver disease (MELD) score of > 9 indicates inadequate liver function reserve in patients with HCC undergoing LR. AIMS: We used these two parameters to predict the overall survival (OS) of patients with Barcelona clinic liver cancer (BCLC) Stage B HCC who underwent LR or transcatheter arterial chemoembolization (TACE). METHODS AND RESULTS: We consecutively enrolled patients with BCLC stage B HCC and Child-Pugh Class A liver disease underwent LR or TACE. Of these patients, 163 underwent LR and 270 underwent TACE. We used two parameters, that is, ≤ 3 nodules and a MELD score of ≤ 9, to subclassify BCLC stage B HCC patients. BCLC B1 had to occur concomitantly with two parameters, whereas for BCLC B2, meeting only one criterion was sufficient. The five-year OS of BCLC B1 patients undergoing LR was 60% and those undergoing TACE was 37% (p = 0.007). The 5-year OS of BCLC B2 patients undergoing LR was 23% and those undergoing TACE was 18% (p = 0.223). CONCLUSION: We recommend considering LR for BCLC B1 patients, whereas TACE could be considered for BCLC B2 patients.