Tumor number and Model for End-Stage Liver Disease score as selection criteria for resection or embolization of intermediate-stage hepatocellular carcinoma

Purpose The majority of patients with Barcelona Clinic liver cancer (BCLC) stage B hepatocellular carcinoma (HCC) undergoing liver resection (LR) have ≤ 3 nodules, a phenomenon noted worldwide. Well-preserved liver function is an essential prerequisite for LR. We used these two variables to select patients suitable for LR for BCLC stage B HCC. Methods We consecutively enrolled patients with BCLC stage B HCC and Child–Pugh class A liver disease. Of these patients, 163 underwent LR and 270 underwent transarterial chemoembolization (TACE). Based on a previous study, we specified a Model for End-Stage Liver Disease (MELD) score of ≤ 9 as indicating well-preserved liver function. We defined patients with ≤ 3 nodules and a MELD score of ≤ 9 as BCLC B1 and those with > 3 nodules or a MELD score of > 9 as BCLC B2. Results The five-year overall survival (OS) of BCLC B1 patients undergoing LR was 60% and those undergoing TACE was 37% (p = 0.007). The five-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.