A classification model for resectability in hepatocellular carcinoma patients

Aim Some patients undergoing liver resection for hepatocellular carcinoma (HCC) have poor outcomes. Therefore, we aimed to propose a new resectability classification for patients with HCC. Methods We classified patients into three categories: resectable (R), borderline resectable (BR), and unresectable (UR). Patients ( n = 409) who underwent hepatectomy for HCC were assigned to the non‐UR (R and BR classes combined; n = 285) and UR‐HCC classes ( n = 68; training cohort). Patient characteristics in the BR‐HCC and R‐HCC groups were compared. The new criteria were tested in a validation cohort ( n = 295). Results Of the 285 patients, 229 and 56 were classified into the R‐ and BR‐HCC classes, respectively, using macrovascular invasion, tumor size, and future liver remnant/modified albumin‐bilirubin scores. Patients with BR‐HCC demonstrated significantly worse progression‐free and overall survival ( p < 0.0001 and p < 0.0001, respectively) than patients with R‐HCC in the training cohort. Similar results were observed in the validation cohort. Multivariate analysis of the non‐UR‐HCC group in the training cohort revealed that the tumor number and BR‐HCC were independent predictive factors for poor overall survival. Conclusions This classification can help select patients with BR‐HCC for preoperative treatment before considering surgery.