Chetana Lim1, Prashant Bhangui2, Chady Salloum1, Concepción Gómez-Gavara1, Eylon Lahat1, Alain Luciani3, Philippe Compagnon4, Julien Calderaro5, Cyrille Feray6, Daniel Azoulay7. 1. Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France. 2. Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, New Delhi, India. 3. Université Paris-Est UPEC, Créteil, France; INSERM, U955, Créteil, France; Department of Radiology, Henri Mondor Hospital, Créteil, France. 4. Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France; Université Paris-Est UPEC, Créteil, France; INSERM, U955, Créteil, France. 5. Université Paris-Est UPEC, Créteil, France; INSERM, U955, Créteil, France; Department of Pathology, Henri Mondor Hospital, Créteil, France. 6. Université Paris-Est UPEC, Créteil, France; Department of Hepatology, Henri Mondor Hospital, Créteil, France. 7. Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France; Université Paris-Est UPEC, Créteil, France; INSERM, U955, Créteil, France. Electronic address: daniel.azoulay@aphp.fr.
Abstract
BACKGROUND & AIMS: The Barcelona Clinic Liver Cancer (BCLC) guidelines recommend resection for very early and early single hepatocellular carcinoma (HCC) patients. It is not known whether a delay in resection from the time of diagnosis (the time to surgery [TTS], i.e. the elapsed time from diagnosis to surgery) affects outcomes. We aim to evaluate the impact of TTS on recurrence and survival outcomes in patients with HCC. METHODS: All patients resected for BCLC stage 0-A single HCC from 2006 to 2016 were studied to evaluate the impact of TTS on recurrence rate, recurrence-free survival (RFS), transplantability following recurrence, and intention-to-treat overall survival (ITT-OS). Propensity score matching (PSM) was further performed to ensure comparability. RESULTS: The study population included 100 patients. Surgery was performed between 0.6 and 77 months after diagnosis (median TTS: three months; interquartile range: 1.8-4.6 months). There was no post-operative mortality. Compared to those with TTS <3 months, patients with TTS ≥3 months (70% of these patients had TTS 3-6 months) had a higher post-operative morbidity (36% vs. 16%, p = 0.02), a similar tumor recurrence rate (32% vs. 32%, p = 1.00), RFS (37% vs. 48%, p = 0.42), transplantability following tumor recurrence (63% vs. 50%, p = 0.48), and five-year ITT-OS (82% vs. 80%, p = 0.20). Similar results were observed after PSM. CONCLUSION: Patients with BCLC stage 0-A single HCC can undergo surgery with TTS ≥3 months without impaired oncologic outcomes. An increase in the TTS within a safe range could allow time for proper evaluation before surgery, and ethical testing of new neoadjuvant treatments, aiming to reduce the high rate of tumor recurrence despite curative resection. LAY SUMMARY: A delay of ≥3 months in time to resection after diagnosis in HCC patients meeting the European Association for the Study of Liver Disease/American Association for the Study of Liver Disease criteria for resection does not affect oncological and long-term outcomes compared to those with a delay to surgery of <3 months.
BACKGROUND & AIMS: The Barcelona Clinic Liver Cancer (BCLC) guidelines recommend resection for very early and early single hepatocellular carcinoma (HCC) patients. It is not known whether a delay in resection from the time of diagnosis (the time to surgery [TTS], i.e. the elapsed time from diagnosis to surgery) affects outcomes. We aim to evaluate the impact of TTS on recurrence and survival outcomes in patients with HCC. METHODS: All patients resected for BCLC stage 0-A single HCC from 2006 to 2016 were studied to evaluate the impact of TTS on recurrence rate, recurrence-free survival (RFS), transplantability following recurrence, and intention-to-treat overall survival (ITT-OS). Propensity score matching (PSM) was further performed to ensure comparability. RESULTS: The study population included 100 patients. Surgery was performed between 0.6 and 77 months after diagnosis (median TTS: three months; interquartile range: 1.8-4.6 months). There was no post-operative mortality. Compared to those with TTS <3 months, patients with TTS ≥3 months (70% of these patients had TTS 3-6 months) had a higher post-operative morbidity (36% vs. 16%, p = 0.02), a similar tumor recurrence rate (32% vs. 32%, p = 1.00), RFS (37% vs. 48%, p = 0.42), transplantability following tumor recurrence (63% vs. 50%, p = 0.48), and five-year ITT-OS (82% vs. 80%, p = 0.20). Similar results were observed after PSM. CONCLUSION: Patients with BCLC stage 0-A single HCC can undergo surgery with TTS ≥3 months without impaired oncologic outcomes. An increase in the TTS within a safe range could allow time for proper evaluation before surgery, and ethical testing of new neoadjuvant treatments, aiming to reduce the high rate of tumor recurrence despite curative resection. LAY SUMMARY: A delay of ≥3 months in time to resection after diagnosis in HCC patients meeting the European Association for the Study of Liver Disease/American Association for the Study of Liver Disease criteria for resection does not affect oncological and long-term outcomes compared to those with a delay to surgery of <3 months.
Authors: Benjamin Gravesteijn; Eline Krijkamp; Jan Busschbach; Geert Geleijnse; Isabel Retel Helmrich; Sophie Bruinsma; Céline van Lint; Ernest van Veen; Ewout Steyerberg; Kees Verhoef; Jan van Saase; Hester Lingsma; Rob Baatenburg de Jong Journal: Value Health Date: 2021-03-05 Impact factor: 5.725
Authors: Rajalakshmi Govalan; Michael Luu; Marie Lauzon; Kambiz Kosari; Joseph C Ahn; Nicole E Rich; Nicholas Nissen; Lewis R Roberts; Amit G Singal; Ju Dong Yang Journal: Hepatol Commun Date: 2021-08-25
Authors: Eva Braunwarth; Stefan Stättner; Margot Fodor; Benno Cardini; Thomas Resch; Rupert Oberhuber; Daniel Putzer; Reto Bale; Manuel Maglione; Christian Margreiter; Stefan Schneeberger; Dietmar Öfner; Florian Primavesi Journal: Eur Surg Date: 2018-05-17 Impact factor: 0.953