Assessing the Validity of the AASLD Surgical Treatment Algorithm in Patients with Early-Stage Hepatocellular Carcinoma
- Author:
Aryoung KIM
1
;
Byeong Geun SONG
;
Wonseok KANG
;
Geum-Youn GWAK
;
Yong-Han PAIK
;
Moon Seok CHOI
;
Joon Hyeok LEE
;
Myung Ji GOH
;
Dong Hyun SINN
Author Information
- Publication Type:Original Article
- From:Gut and Liver 2025;19(2):265-274
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background/Aims:The aim of this study was to investigate the effect of a surgical treatment algorithm recently proposed by the American Association for the Study of Liver Diseases (AASLD) on survival outcomes in patients with early-stage hepatocellular carcinoma (HCC) and identify effective alternative treatment modalities when liver transplantation (LT) is not available.
Methods:We studied the clinical data of 1,442 patients who were diagnosed with early-stage HCC (a single lesion measuring 2–5 cm in size or 2 to 3 lesions measuring ≤3 cm in size) be-tween 2013 and 2018 and classified as Child-Turcotte-Pugh (CTP) A or B. Analyses were separately performed for individuals recommended for resection (single lesion, CTP A and no clinically significant portal hypertension) and those recommended for LT (single lesion with impaired liver function such as CTP B or clinically significant portal hypertension or multiple lesions).
Results:Of 791 patients recommended for surgical resection, 85.8% underwent resection. The 5-year survival rate was higher for patients who underwent surgical resection than for those who received other treatments (89.4% vs 72.3%). Among 651 patients recommended for LT, only 3.4% underwent the procedure. The most common alternative treatment modalities were transarterial therapy (39.3%) followed by resection (28.9%) and ablation (27.8%). The overall survival rate associated with transarterial therapy was lower than that for resection and ablation, whereas that of the latter two treatments were comparable.
Conclusions:The survival outcomes of treatment strategies that most closely aligned with the algorithm proposed by the AASLD were superior to those of alternative treatment approaches.However, LT in patients with early-stage HCC can be challenging. When LT is not feasible, resection and ablation can be considered first-line alternative options.
