Recent advances in systemic therapy for hepatocellular carcinoma (HCC) have led to debates about the feasibility of combination therapies, such as systemic therapy combined with surgery or transarterial chemoembolization, for patients with advanced HCC. However, a lack of consensus on the oncological resectability criteria has hindered discussions of "conversion therapy" and the optimal management in patients with HCC. To address this issue, the Japan Liver Cancer Association (JLCA) and the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS) established a working group and discussed the concept of borderline resectable HCC. Herein, we present a consensus statement from this expert panel on the resectability criteria for HCC from the oncological standpoint under the assumption of technically and liver-functionally resectable situations. The criteria for oncological resectability in HCC are classified into three grades: resectable, representing an oncological status for which surgery alone may be expected to offer clearly better survival outcomes as compared with other treatments; borderline resectable 1, representing an oncological status for which surgical intervention as a part of multidisciplinary treatment may be expected to offer survival benefit; and borderline resectable 2, representing an oncological status for which the efficacy of surgery is uncertain and the indication for surgery should be determined carefully under the standard multidisciplinary treatment. These criteria aim to provide a common language for discussing and analyzing the treatment strategies for advanced HCC. It is also expected that these criteria will be optimized, modified, and updated based on further advancements in systemic therapies and future validation studies.

中文翻译：

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新型全身治疗时代肝细胞癌的肿瘤可切除性标准：日本肝癌协会和日本肝胆胰外科学会专家共识声明 2023。


肝细胞癌 （HCC） 全身治疗的最新进展引发了关于晚期 HCC 患者联合治疗（例如全身治疗联合手术或经动脉化疗栓塞术）的可行性的争论。然而，对肿瘤学可切除性标准缺乏共识阻碍了对 HCC 患者“转化疗法”和最佳治疗的讨论。为了解决这个问题，日本肝癌协会 （JLCA） 和日本肝胆胰外科学会 （JSHBPS） 成立了一个工作组，并讨论了临界可切除 HCC 的概念。在此，我们提出了该专家组在技术和肝功能可切除情况下，从肿瘤学角度关于 HCC 可切除标准的共识声明。HCC 肿瘤学可切除性的标准分为三个等级：可切除，代表一种肿瘤状态，与其他治疗相比，单独手术可能有望提供明显更好的生存结果;临界可切除 1，代表一种肿瘤状态，对于这种状态，作为多学科治疗的一部分，手术干预可能有望提供生存获益;和临界可切除 2，代表手术疗效不确定的肿瘤状态，应在标准多学科治疗下仔细确定手术适应症。这些标准旨在为讨论和分析晚期 HCC 的治疗策略提供一种通用语言。预计这些标准将根据全身治疗的进一步进展和未来的验证研究进行优化、修改和更新。