Impact of Borderline Resectable Criteria on Hepatocellular Carcinoma Treatment From the Perspective of Tumor Burden.

[BACKGROUND] The classification of oncological resectability for hepatocellular carcinoma (HCC) has been established, requiring validation of treatment outcomes for hepatectomy and systemic chemotherapy.

[METHODS] The study evaluated treatment outcomes in 978 patients who underwent hepatectomy and 222 patients with HCC who received first-line systemic chemotherapy (atezolizumab plus bevacizumab, lenvatinib, or durvalumab plus tremelimumab).

[RESULTS] Among three factors defining patients with borderline resectable 1 (BR1) and 2 (BR2), macrovascular invasion factor was associated with significantly worse prognosis in a hepatectomy group (BR1: 34.2 vs. 63.4 months, p = 0.04; BR2: 14.4 vs. 20.9 months, p = 0.004). In contrast, in the systemic chemotherapy group, none of the three factors affected prognosis in either BR1 or BR2 patients. In BR2 patients undergoing hepatectomy, those with a single risk factor had significantly better outcomes than those with 2-3 factors (20.1 vs. 12.6 months, p < 0.001). Similarly, in the entire systemic chemotherapy cohort, patients with a single risk factor had better outcomes than those with 2-3 (22.6 vs. 11.9 months, p = 0.001). However, among chemotherapy responders (per modified Response Evaluation Criteria in Solid Tumors), prognosis did not significantly differ between those with one factor and those with 2-3 factors (25.4 vs. 24.5 months, p = 0.502).

[CONCLUSION] Macrovascular invasion significantly impacted prognosis in patients undergoing hepatectomy, for both BR1 and BR2, whereas any of the tumor factors did not affect the prognosis of patients receiving systemic chemotherapy. Tumor burden correlated with prognosis in the entire cohort but not in chemotherapy responders, suggesting effective treatment may overcome poor prognostic indicators.