Supplementary Material for: Oncological Resectability Criteria for Hepatocellular Carcinoma in the Era of Novel Systemic Therapies: the JLCA and JSHBPS Expert Consensus Statement 2023

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 (R), 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 (BR1), 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 (BR2), 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.

近年来，肝细胞癌（hepatocellular carcinoma, HCC）系统治疗领域的进展，引发了晚期HCC患者联合治疗方案可行性的讨论，诸如系统治疗联合手术或经动脉化疗栓塞术（transarterial chemoembolization）这类联合策略。然而，当前肿瘤学可切除性标准尚未达成共识，这一局限阻碍了针对HCC患者“转化治疗”及最优管理方案的探讨。为解决这一问题，日本肝癌协会（Japan Liver Cancer Association, JLCA）与日本肝胆胰外科学会（Japanese Society of Hepato-biliary-pancreatic Surgery, JSHBPS）联合成立工作组，就临界可切除HCC的概念展开研讨。本文呈现了该专家小组基于肿瘤学视角，在技术可切除且肝功能耐受的前提下，针对HCC可切除性标准达成的共识声明。HCC的肿瘤学可切除性标准分为三个等级：可切除（R级），指相较其他治疗方案，单纯手术即可明确获得更优生存结局的肿瘤学状态；临界可切除1级（BR1），指作为多学科治疗组成部分的手术干预，有望为患者带来生存获益的肿瘤学状态；临界可切除2级（BR2），指手术疗效尚不明确，需在标准多学科治疗框架下谨慎评估手术指征的肿瘤学状态。上述标准旨在为晚期HCC治疗策略的探讨与分析提供统一的学术话语体系。同时，随着系统治疗领域的进一步发展及未来验证性研究的推进，该标准也将得到优化、修正与更新。