Real-world role of performance status in surgical resection for hepatocellular carcinoma: A multicenter study

Han Wu, Hao Xing, Lei Liang, Bin Huang, Chao Li, Wan Yee Lau, Ya Hao Zhou, Wei Min Gu, Hong Wang, Ting Hao Chen, Yao Ming Zhang, Yong Yi Zeng, Timothy M. Pawlik, Ming Da Wang, Meng Chao Wu, Feng Shen, Tian Yang

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background: The Barcelona Clinic Liver Cancer (BCLC) categorizes a patient with performance status (PS)-1 as advanced stage of hepatocellular carcinoma (HCC) and surgical resection is not recommended. In real-world clinical practice, PS-1 is often not a contraindication to surgery for HCC. The aim of current study was to define the impact of PS on the surgical outcomes of patients undergoing liver resection for HCC. Methods: 1,531 consecutive patients who underwent a curative-intent resection of HCC between 2005 and 2015 were identified using a multi-institutional database. After categorizing patients into PS-0 (n = 836) versus PS-1 (n = 695), perioperative mortality and morbidity, overall survival (OS) and recurrence-free survival (RFS) were compared. Results: Overall perioperative mortality and major morbidity among patients with PS-0 (n = 836) and PS-1 (n = 695) were similar (1.4% vs. 1.6%, P = 0.525 and 9.7% vs. 10.2%, P = 0.732, respectively). In contrast, median OS and RFS was worse among patients who had PS-1 versus PS-0 (34.0 vs. 107.6 months, and 20.5 vs. 60.6 months, both P < 0.001, respectively). On multivariable Cox-regression analyses, PS-1 was independently associated with worse OS (HR: 1.301, 95% CI: 1.111–1.523, P < 0.001) and RFS (HR: 1.184, 95% CI: 1.034–1.358, P = 0.007). Conclusions: Patients with PS-1 versus PS-0 had comparable perioperative outcomes. However, patients with PS-1 had worse long-term outcomes as PS-1 was independently associated with worse OS and RFS. Routine exclusion of HCC patients with PS-1 from surgical resection as recommended by the BCLC guidelines is not warranted.

Original languageEnglish
Pages (from-to)2360-2368
Number of pages9
JournalEuropean Journal of Surgical Oncology
Issue number12
StatePublished - Dec 2019
Externally publishedYes


  • Hepatectomy
  • Hepatocellular carcinoma
  • Performance status
  • Recurrence
  • Survival


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