Patients with Favorable Prognosis among Those Selected for Liver Resection for Intermediate-Stage Hepatocellular Carcinoma

Background Many studies have reported preoperative predictors of overall survival (OS) of patients undergoing liver resection (LR) for Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC); however, their results are inconsistent.Methods We included 170 patients with BCLC stage B undergoing LR during 2011–2021.Results Multivariate analysis showed that alpha-fetoprotein (AFP) >50 ng/ml (hazard ratio [HR] = 1.959; 95% confidence interval [CI] = 1.156–3.319; p = 0.012), undergoing major resection (HR = 2.514; 95% CI = 1.225–5.161; p = 0.012), and indocyanine green retention rate at 15 min ≥10% (HR = 1.777; 95% CI = 1.038–3.040; p = 0.036) were associated with overall mortality. We constructed a predictive model with these variables. The model provided three risk strata for 5-year OS, low risk, medium risk, and high risk, with 5-year OS of 58%, 30%, and 12%, respectively (p < 0.001). The c-index of this model was 64.7%. The calibration plots showed overall high agreement between model predictions and observed outcomes.Conclusions The risk prediction model we developed to predict the OS of patients undergoing LR for BCLC stage B HCC is helpful for treatment decision-making.