Risk factors and long-term prognosis of beyond-Milan recurrence after hepatectomy for BCLC stage 0/A hepatocellular carcinoma: A large-scale multicenter study.

Abstract

BACKGROUND:

Data on recurrence are important to inform surveillance and improve long-term surgical outcomes for patients with hepatocellular carcinoma. We sought to identify risk factors and long-term prognosis among patients who experienced beyond-Milan recurrence after hepatectomy for early-stage hepatocellular carcinoma.

METHODS:

Patients who underwent hepatectomy for Barcelona Clinic Liver Cancer stage 0/A hepatocellular carcinoma were identified from a multi-institutional database. Predictors of beyond-Milan recurrence and risk factors associated with post-recurrence survival among patients with beyond-Milan recurrence were assessed using univariate and multivariate Cox regression analyses.

RESULTS:

Among 753 patients (median follow-up, 51.8 months), 138 (18.3%) developed beyond-Milan recurrence. Regular surveillance (interval follow-up ≤3 months within 1 year and ≤6 months in subsequent years after surgery) was not carried out for 53 (38.4%) patients who developed beyond-Milan recurrence. On multivariate analysis, increased risk of beyond-Milan recurrence was independently associated with preoperative alpha-fetoprotein level >400 ng/mL, tumor size >5.0 cm, multifocal disease, microvascular invasion, and no/irregular recurrence surveillance. Median post-recurrence survival among patients with beyond-Milan recurrence was only 8.4 months (95% confidence interval: 7.0-9.8 months). Among patients who developed beyond-Milan recurrence, Child-Pugh grade B/C, early recurrence within 1 year after surgery, macrovascular invasion/distant metastasis, and noncurative treatment of recurrence were independent risk factors associated with worse post-recurrence survival.

CONCLUSION:

Nearly 1 in 5 patients developed beyond-Milan recurrence after hepatectomy for early-stage hepatocellular carcinoma. Patients with beyond-Milan recurrence had a median survival of less than 1 year after diagnosis of the recurrence. Regular surveillance is an important and actionable measure to decrease beyond-Milan recurrence and, in turn, improve long-term survival among patients treated with hepatectomy for hepatocellular carcinoma.

• Authors: Zi-Han Feng, Ming-Da Wang, Zhong Chen, Li-Yang Sun, Xiao Xu, Qing-Yu Kong, Zi-Xiang Chen, Yong-Yi Zeng, Ying-Jian Liang, Zhi-Yu Chen, Hong Wang, Ya-Hao Zhou, Ting-Hao Chen, Lan-Qing Yao, Chao Li, Timothy M Pawlik, Wan Yee Lau, Feng Shen, Tian Yang
• Journal: Surgery (Surgery) Vol. 172 Issue 4 Pg. 1147-1155 (10 2022) ISSN: 1532-7361 [Electronic] United States
• PMID: 35868902 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2022 Elsevier Inc. All rights reserved.

Chemical References

• alpha-Fetoproteins

Topics

• Carcinoma, Hepatocellular
• Hepatectomy
• Humans
• Liver Neoplasms
• Neoplasm Recurrence, Local (epidemiology, surgery)
• Prognosis
• Retrospective Studies
• Risk Factors
• alpha-Fetoproteins