Survival Outcomes After Liver Resection for Barcelona Clinic Liver Cancer Stage B Hepatocellular Carcinoma Have Improved in the Contemporary Era

Aim The role of liver resection for Barcelona Clinic Liver Cancer stage B (BCLC‐B) hepatocellular carcinoma (HCC) remains debated. Advances in imaging and multidisciplinary therapy have improved outcomes in contemporary practice, in our institution over time. We evaluated era‐specific changes in survival after liver resection for BCLC‐B HCC and shifts in postrecurrence management. Methods This single‐center retrospective cohort analyzed consecutive patients undergoing curative liver resection for BCLC‐A and BCLC‐B disease ( n = 418 and 113) between 2005 and 2021. An exploratory minimum p ‐value approach based on 5‐year overall survival (OS) in BCLC‐B cases was used to determine a candidate cutoff for era stratification. Patients were divided into early and modern eras; survival outcomes were compared using propensity score matching. Results The 5‐year OS of BCLC‐B patients improved from 44% before 2014 to 74% after 2015 ( p < 0.05), whereas 5‐year disease‐free survival (DFS) increased from 5% to 22% ( p < 0.05). Postrecurrence management shifted toward greater use of radiofrequency ablation/percutaneous ethanol injection therapy and systemic therapy with tyrosine kinase inhibitors or immune checkpoint inhibitors, with a relative decline in transarterial chemoembolization. In the contemporary era, 5‐year OS of BCLC‐B approximated that of BCLC‐A (74% vs. 72%, p = 0.97), though DFS remained lower (22% vs. 45%, p < 0.05). Even after propensity score matching, the improvement in OS and DFS after 2015 remained significant ( p < 0.05). Conclusions Survival after liver resection for BCLC‐B HCC has improved substantially in the modern era, achieving 5‐year OS comparable to BCLC‐A. Resection should be considered for appropriately selected BCLC‐B patients within advanced multidisciplinary care.