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Page 6 of 10 Yamaguchi et al. Hepatoma Res 2018;4:50 I http://dx.doi.org/10.20517/2394-5079.2018.68

Table 1. The result of hepatic resection for HCC
Author HCC characteristics 1-year OS (%) 3-year OS (%) 5-year OS (%)
Garancini et al. [65] BCLC A/B 95/83.3 61.1/50 46.2/41.2
Wu et al. [66) BCLC 0-A 95.9 85.3 67.6
Jiang et al. [67] BCLC A, multifocal 96 71.7 36.3
Li et al. [68] BCLC A or B, ruptured 66.3 23.4 10.1
Xu et al. [69] BCLC B or C 81.4 48.5 28.2
Wang et al. [70] Small tumors 92.6 83.3 73
Shrager et al. [71] Large HCC (> 10 cm) 57 30 19
Lee et al. [72] Large HCC (> 10 cm) 66 44 31
Shah et al. [73] Large HCC 69 63 54
Pandey et al. [74] Large HCC 63 35 28.6
Ng et al. [75] Large or multinodular 74 50 39
Roayaie et al. [76] Macroscopic vascular invasion 52 22 14
Pawilk et al. [20] Portal or hepatic vein invasion 45 17 10
Ban et al. [77] Portal vein thrombosis 70 37 22
Vitale et al. [78] BCLC-C 55 44 0
HCC: hepatocellular carcinoma; OS: overall survival; BCLC: Barcelona Clinic Liver Cancer

to have a poor prognosis. The Glasgow Prognostic Score (GPS) is one of the important predictors and is believed
to make the prognoses of HCC patients clearer . In addition, some studies have shown that the preoperative
[61]
neutrophil-lymph node ratio (NLR) is a predictor of poor prognosis . Sarcopenia is also considered to be a
[62]
predictor of poor prognosis . Japanese study showed that patients with non-B non-C HCC had a better
[63]
prognosis and a lower risk of recurrence than those with hepatitis C virus (HCV)-related HCC .
[64]
We investigated the outcomes of HCC after hepatic resection [65-78] . There are no significant difference
mortality of HCC patients between BCLC A and B [Table 1]. Garancini said that surgical treatment of HCC
in BCLC stage B should not be considered contraindicated for such patients. HCC patients with vascular
invasions had higher mortality rate than single large HCC. We should pay attention to vascular invasions
more than tumor size for good surgical prognosis.

At last, we showed outcomes of hepatic resection in Japan. The Liver Cancer Study Group of Japan determined
that the cumulative survival rate at all HCC stages was 90.2% at 1 year, 81.3% at 2 years, and 56.8%
[64]
at 5 years. Looking at the 5-year survival rate by tumor diameter, survival rate was 73.9% in patients with
tumor size of less than 2 cm (n = 4168), 63.1% in patients with tumor size of 2 to 3 cm (n = 7212), 59.7% in
patients with tumor size of 3 to 5 cm (n = 6022), and 52.4% in patients with tumor size of 5 to 10 cm (n = 3869).
The 5-year survival rate of patients with tumor size of 10 cm and bigger was 45.4%. Thus, patients with
increasing tumor size have a worse prognosis. Looking at survival rate by the number of tumors, while the
1-year survival rate and the 5-year survival rate were 90% and 50% to 60% respectively in patients with one
or two tumors, the 5-year survival rate declined to 37% in patients with more than three tumors [Table 2].
Looking at the 5-year survival rate by stage, survival rate was 82.8%, 70%, 52%, 31%, and 26.8% in patients at
stage I, II, III, IVA, and IVB, respectively. However, the 5-year survival rate has been increasing steadily in
recent years. While it was 12.5% in the 1980s, it steadily increased to 44% in the 2000s.

The incision criteria are different in each guideline. But, expansion of criteria for resection is progressing.
The survival rate of HCC after hepatic resection is expected to increase with better outcomes of hepatectomy
in the future.

CONCLUSION
This paper has described indications for hepatectomy for patients with HCC through comparison of domestic
guidelines with overseas guidelines, focusing on their differences.