Oncological Outcomes and Treatment Strategies for Borderline Resectable Hepatocellular Carcinoma Based on the Oncological Resectability Classification.

Background: Although hepatic resection is the most effective curative treatment for hepatocellular carcinoma (HCC) in selected patients, survival outcomes can vary significantly depending on tumor burden and biology. To provide a standardized framework, the oncological resectability classification introduced in 2023 stratifies patients into resectable (R), borderline resectable 1 (BR1), or borderline resectable 2 (BR2). However, the optimal management of patients with BR1 and BR2 in the era of novel systemic therapies remains uncertain. The present study evaluated the surgical validity and treatment strategies for patients with BR1 and BR2, based on this classification. Methods: A retrospective analysis was conducted on 184 patients who underwent initial hepatic resection for HCC at Nagasaki University Hospital between 2014 and 2024. Clinical variables, perioperative outcomes, the recurrence-free survival (RFS), and the overall survival (OS) were then compared across the 3 groups: R ( Results: The 5-year RFS rates were 43.9% for R, 39.3% for BR1, and 20.0% for BR2 ( Conclusions: BR1 patients, particularly those without vascular invasion, may achieve survival comparable to that of R. In contrast, BR2 patients generally show dismal outcomes with surgery alone, underscoring the necessity of systemic or multimodal approaches. Tailored strategies are essential for optimizing outcomes in patients with borderline resectable HCC.