Outcomes of reduction hepatectomy combined with postoperative multidisciplinary therapy for advanced hepatocellular carcinoma

Table 1 Clinical and surgical data

Clinical data			Surgical data
Age (yr)	62.8 ± 11.8		Anatomical hepatectomy	-	3
				+	27
Sex	Male	28	Operation time (min)	340
	Female	2
HBV/HCV	-	6	Blood loss (mL)	690
	+	24
Alb (g/dL)	3.71 ± 0.08		Number of tumors in the remnant liver	1-3	12
				≥ 4	18
T-Bil (mg/dL)	0.88 ± 0.08		POCR	+	8
				-	22
PT (%)	90.19 ± 2.75
ICGR15 (%)	17.34 ± 1.96
AFP (ng/mL)	102288 ± 7287
PIVKA-II (AU/mL)	52534 ± 22566
Child-pugh class	A	27
	B	3
Number of tumors	St	0
	Mt	30
Tumor size (cm)	10.13 ± 1.02
Differentiation	Wel	1
	Mod	16
	Por	13
pN	-	28
	+	2
Macrovascular invasion	-	5
	+	25
BCLC stage	B	12
	C	18
Distant metastasis	-	27
	+	3

PT: Prothrombin time; ICGR15: Indocyanine green retention rate at 15 min; AFP: Alpha-fetoprotein; PIVKA-II: Protein induced by vitamin K absence/antagonist-II; BCLC: Barcelona Clinic Liver Cancer.

Table 2 Peri-surgical treatment

Preoperative treatment
No treatment	24
TAI	4
TAI + ERT	1
TAI + TKI1 + ERT	1
Postoperative treatment	Total	POCR (+)
TAI + hepatectomy + lung resection + chemo	1	1
Hepatectomy + chemo + TAI + ERT	1	1
Lung resection + LAT + TAI + chemo + ERT	1	1
Lung resection + LAT	1	0
Brain tumor resection + TAI + TKI2 + chemo + ERT	1	0
LAT + TAI + ERT	2	2
TAI + TKI3 + chemo ( + ERT)	3	0
TAI + TKI4	2	0
TAI + chemo ( + ERT)	6	1
TAI ( + ERT)	9	2
ERT	1	0
No treatment	1	0
Unknown	1	0
Total	30	8

¹TKI: Sorafenib (n = 1).

²TKI: Sorafenib (n = 1).

³TKI: Sorafenib (n = 1), lenvatinib (n = 1), sorafenib + lenvatinib (n = 1).

⁴TKI: Sorafenib (n = 1), sorafenib + lenvatinib (n = 1). TAI: Transarterial infusion; ERT: External beam radiotherapy; TKI: Tyrosine kinase inhibitors; LAT: Local ablation therapy.

Table 3 Univariate analyses

Clinicopathological data					Surgical data
	Category	n	MST (m)	P value		Category	n	MST (m)	P value
Age (yr)	≥ 60	18	17.9	0.9267	Anatomical hepatectomy	-	3	39.0	0.2162
	< 60	12	29.7			+	27	16.9
Sex	Male	28	17.9	0.1584	Operation time (min)	< 340	15	28.4	0.4177
	Female	2	-			≥ 340	15	14.8
HBV/HCV	-	6	15.0	0.2674	Blood loss (mL)	< 690	15	29.7	0.6355
	+	24	29.7			≥ 690	15	16.4
Alb (g/dL)	≥ 3.7	15	33.5	0.3444	Number of tumors in the remnant liver	1-3	12	56.5	0.0283a
	< 3.7	15	17.4			≥ 4	18	14.8
T-Bil (mg/dL)	≤ 0.8	19	28.4	0.5131	POCR	+	8	56.6	0.0041a
	> 0.8	11	16.5			-	22	14.8
PT (%)	≥ 90	17	17.9	0.7839
	< 90	13	28.4
ICGR15 (%)	≥ 15	12	29.7	0.6790
	< 15	18	16.5
AFP (ng/mL)	< 200	16	29.7	0.5569
	≥ 200	14	17.9
PIVKA-II (AU/mL)	< 100	3	73.2	0.0584
	≥ 100	27	16.9
Child-pugh class	A	27	29.7	< 0.0001
	B	3	6.4
Tumor size (cm)	≥ 10 cm	15	12.2	0.0485
	< 10 cm	15	29.7
Differentiation	wel/mod	17	17.9	0.5449
	por	13	28.4
pN	-	28	17.9	0.2335
	+	2	56.5
Macrovascular invasion	-	5	9.5	0.0053
	+	25	30.0
BCLC stage	B	12	33.8	0.7652
	C	18	16.9
Distant metastasis	-	27	28.4	0.6013
	+	3	12.1

^aP < 0.05. MST: Mean survival time; PT: Prothrombin time; ICGR15: Indocyanine green retention rate at 15 min; AFP: Alpha-fetoprotein; PIVKA-II: Protein induced by vitamin K absence/antagonist-II; BCLC: Barcelona Clinic Liver Cancer.

Table 4 Comparison between the postoperative complete remission (+) and postoperative complete remission (-) groups

	Category	POCR (+)	POCR (-)	P value
Age	< 60/≥ 60	1/7	11/11	0.0994
Sex	Male/female	7/1	21/1	0.4690
HBV and/or HCV	-/ +	0/8	6/16	0.1550
Alb (g/dL)	< 3.7/≥ 3.7	5/3	10/12	0.6817
T-Bil (mg/dL)	≤ 0.8/> 0.8	6/2	13/9	0.6722
PT (%)	< 90/≥ 90	4/4	9/13	0.6976
ICGR15 (%)	< 15/≥ 15	4/4	14/8	0.6779
AFP (ng/mL)	< 200/> 200	4/4	12/10	1.0000
PIVKA-II	< 100/≥ 100	2/6	1/21	0.1655
Child-pugh class	A/B	8/0	19/3	0.5448
Tumor size (cm)	< 10/≥ 10	5/3	10/12	0.6817
Differentiation	wel or mod/por	5/3	12/10	1.0000
pN	-/ +	7/1	21/1	0.4690
Macrovascular invasion	-/ +	0/8	5/17	0.2868
Distant metastasis	-/ +	8/0	19/3	0.5448
BCLC stage	B/C	3/5	9/13	1.0000
Anatomical hepatectomy	-/ +	2/6	1/21	0.1665
Number of tumors in the remnant liver	1-3/≥ 4	7/1	5/17	0.0025a

^aP < 0.05. POCR: Postoperative complete remission; PT: Prothrombin time; ICGR15: Indocyanine green retention rate at 15 min; AFP: Alpha-fetoprotein; PIVKA-II: Protein induced by vitamin K absence/antagonist-II; BCLC: Barcelona Clinic Liver Cancer.

Table 5 Comparison between the postoperative complete remission (-) tyrosine kinase inhibitors (+) and postoperative complete remission (-)tyrosine kinase inhibitors (-) groups

	Category	POCR (-)/TKI (+)	POCR (-)/TKI (-)	P value
Age	< 60/≥ 60	4/2	7/9	0.6351
Sex	Male/female	6/0	15/1	1.0000
HBV and/or HCV	-/ +	2/4	4/12	1.0000
Alb (g/dL)	< 3.7/≥ 3.7	1/5	9/7	0.1619
T-Bil (mg/dL)	≤ 0.8/> 0.8	4/2	9/7	1.0000
PT (%)	< 90/≥ 90	2/4	7/9	1.0000
ICGR15 (%)	< 15/≥ 15	4/2	10/6	1.0000
AFP (ng/mL)	< 200/> 200	4/2	8/8	0.6462
PIVKA-II	< 100/≥ 100	0/6	1/15	1.0000
Child-pugh class	A/B	6/0	13/3	0.5325
Tumor size (cm)	< 10/≥ 10	4/2	6/10	0.3476
Differentiation	Wel or mod/por	4/2	8/8	0.6462
pN	-/ +	5/1	16/0	0.2727
Macrovascular invasion	-/ +	0/6	5/11	0.2663
Distant metastasis	-/ +	5/1	14/2	1.0000
BCLC stage	B/C	2/4	7/9	1.0000
Anatomical hepatectomy	-/ +	0/6	1/15	1.0000
Number of tumors in the remnant liver	1-3/≥ 4	0/6	5/11	0.2663

POCR: Postoperative complete remission; TKIs: Tyrosine kinase inhibitors; PT: Prothrombin time; ICGR15: Indocyanine green retention rate at 15 min; AFP: Alpha-fetoprotein; PIVKA-II: Protein induced by vitamin K absence/antagonist-II; BCLC: Barcelona Clinic Liver Cancer.