Ha Il Kim1, Jihyun An2, Ji Yoon Kim3, Hyun Phil Shin1, Seo Young Park4, Gi-Won Song5,6, Han Chu Lee3,5, Ju Hyun Shim3,5. 1. Gastroenterology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea. 2. Gastroenterology and Hepatology, Hanyang University College of Medicine, Guri, Republic of Korea. 3. Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. 4. Statistics and Data Science, Korea National Open University, Seoul, Republic of Korea. 5. Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. 6. Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Abstract
Introduction: In spite of the high frequency of recurrence of hepatocellular carcinoma (HCC) after resection, little evidence exists to directly help to plan a reasonable schedule for the frequency and intensity of postoperative surveillance for recurrence. Methods: 1,918 consecutive patients with Child-Turcott-Pugh class A who had T1- or T2-staged HCCs detected by active surveillance and underwent curative resection for their tumors at 3 teaching hospitals in Korea, followed by recurrence screening at 6-monthly or shorter intervals. To set an evidence-based timetable for postoperative surveillance, we investigated the annual hazard rate of recurrence through postoperative year 10 in patients undergoing hepatectomy for HCC, and the clinical and morphological phenotypes associated with early versus late recurrence. Results: The estimated hazard rate for recurrence peaked during year 0-1 (21.7%), with a subsequent gradual decrease through 5 years, followed by stabilization at <7.0% until year 10, except in the case of cirrhotics, who had a rate of 10.5% during year 4-5. Multivariate time-to-recurrence analysis by recurrence period revealed that serum alpha-fetoprotein ≥200 ng/mL, larger size of tumor, tumor multiplicity, microvascular invasion, capsular invasion, and higher METAVIR fibrosis stage were significantly related to disease recurrence within 5 years after resection, while cirrhosis (METAVIR F4) alone was related to disease recurrence beyond 5 years (Ps < 0.05). Post-relapse overall survival was better in the latter group (p = 0.033). Conclusions: Our chronological and morphological insights into recurrence after resection of primary HCCs may help implement an optimal intensity of surveillance for recurrence.
Introduction: In spite of the high frequency of recurrence of hepatocellular carcinoma (HCC) after resection, little evidence exists to directly help to plan a reasonable schedule for the frequency and intensity of postoperative surveillance for recurrence. Methods: 1,918 consecutive patients with Child-Turcott-Pugh class A who had T1- or T2-staged HCCs detected by active surveillance and underwent curative resection for their tumors at 3 teaching hospitals in Korea, followed by recurrence screening at 6-monthly or shorter intervals. To set an evidence-based timetable for postoperative surveillance, we investigated the annual hazard rate of recurrence through postoperative year 10 in patients undergoing hepatectomy for HCC, and the clinical and morphological phenotypes associated with early versus late recurrence. Results: The estimated hazard rate for recurrence peaked during year 0-1 (21.7%), with a subsequent gradual decrease through 5 years, followed by stabilization at <7.0% until year 10, except in the case of cirrhotics, who had a rate of 10.5% during year 4-5. Multivariate time-to-recurrence analysis by recurrence period revealed that serum alpha-fetoprotein ≥200 ng/mL, larger size of tumor, tumor multiplicity, microvascular invasion, capsular invasion, and higher METAVIR fibrosis stage were significantly related to disease recurrence within 5 years after resection, while cirrhosis (METAVIR F4) alone was related to disease recurrence beyond 5 years (Ps < 0.05). Post-relapse overall survival was better in the latter group (p = 0.033). Conclusions: Our chronological and morphological insights into recurrence after resection of primary HCCs may help implement an optimal intensity of surveillance for recurrence.
Authors: Al B Benson; Michael I D'Angelica; Daniel E Abbott; Daniel A Anaya; Robert Anders; Chandrakanth Are; Melinda Bachini; Mitesh Borad; Daniel Brown; Adam Burgoyne; Prabhleen Chahal; Daniel T Chang; Jordan Cloyd; Anne M Covey; Evan S Glazer; Lipika Goyal; William G Hawkins; Renuka Iyer; Rojymon Jacob; R Kate Kelley; Robin Kim; Matthew Levine; Manisha Palta; James O Park; Steven Raman; Sanjay Reddy; Vaibhav Sahai; Tracey Schefter; Gagandeep Singh; Stacey Stein; Jean-Nicolas Vauthey; Alan P Venook; Adam Yopp; Nicole R McMillian; Cindy Hochstetler; Susan D Darlow Journal: J Natl Compr Canc Netw Date: 2021-05-01 Impact factor: 11.908