To investigate the prognostic factors and the value of surgical treatment in patients with BCLC-B or C stage hepatocellular carcinoma (HCC).

Clinical data of 110 patients with BCLC-B or C stage HCC admitted to Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from June 2011 to June 2013 were retrospectively analyzed. Among them, 98 patients were male and 12 female, aged 19-74 years with a median age of 51 years. The informed consents of all patients were obtained and the local ethical committee approval was received. The prognostic factors were analyzed by Cox proportional hazards regression model. Survival analysis was conducted with Kaplan-Meier and Log-rank test.

Among the 52 patients with BCLC-B stage HCC, 24 cases received surgical treatments and 28 received non-surgical treatments including TACE in 27 cases, microwave ablation in 1 case. Of the 58 patients with BCLC-C stage HCC, 32 cases underwent surgery and 26 received non-surgical treatments including TACE in 23 patients, oral sorafenib in 3 cases. Cox proportional hazards regression analysis demonstrated that age, model for end-stage liver disease (MELD) score and liver cirrhosis were the independent factors affecting the overall survival of BCLC-B stage HCC patients (HR=0.311, 5.083, 0.355; P<0.05). ALP, macroscopic portal vein tumor thrombus and treatment method were the independent factors affecting the overall survival of BCLC-C stage HCC patients (HR=2.027, 2.908, 0.321; P<0.05). The median survival time of BCLC-C stage HCC patients undergoing surgery was 12 months, significantly better than5 months of those undergoing non-surgical treatments (χ²=23.59, P<0.05). The median survival time of patients with tumor thrombus in the main portal vein was 4 months, significantly worse than 11 months of those with tumor thrombus in the portal branch vein (χ²=14.70, P<0.05).

The efficacy of surgical treatment is better than that of non-surgical treatments for patients with BCLC-C stage HCC. And patients with tumor thrombus in the portal branch vein have better surgical efficacy than those with tumor thrombus in the main portal vein. Age, MELD score and liver cirrhosis, rather than treatment method, are the independent factors affecting the survival and prognosis of patients with BCLC-B stage HCC.