Identification of patients with favorable prognosis after resection in intermediate-stage-hepatocellular carcinoma
- Authors
- Lee, Han Ah; Lee, Minjong; Yoo, Jeong-Ju; Chun, Ho Soo; Park, Yewan; Kim, Hwi Young; Kim, Tae Hun; Seo, Yeon Seok; Sinn, Dong Hyun
- Issue Date
- Feb-2024
- Publisher
- Surgical Association
- Keywords
- hepatocellular carcinoma; intermediate-stage; resection; trans-arterial chemoembolization
- Citation
- International Journal of Surgery, v.110, no.2, pp 1008 - 1018
- Pages
- 11
- Indexed
- SCIE
- Journal Title
- International Journal of Surgery
- Volume
- 110
- Number
- 2
- Start Page
- 1008
- End Page
- 1018
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/65774
- DOI
- 10.1097/JS9.0000000000000941
- ISSN
- 1743-9191
1743-9159
- Abstract
- Backgrounds: It is unclear which patients benefit from resection in intermediate-stage-hepatocellular carcinoma (HCC). The authors aimed to identify high-risk patients for early recurrence among patients with resectable intermediate-stage HCC. Methods: This multicenter retrospective study included patients who underwent resection or trans-arterial chemoembolization (TACE) for intermediate-stage HCC (2008-2019). Multivariable Cox proportional analysis was performed to identify high-risk patients when treated with resection. A prediction score for 2-year recurrence-free survival (RFS) was developed using the training cohort and validated. The 2-year RFS in each risk group was compared with that in TACE group, after propensity score matching (PSM). Results: A total of 1686 patients were included (480 and 1206 patients in the resection and TACE groups). During a median follow-up of 31.4 months, the 2-year RFS was significantly higher in the resection (47.7%) than in the TACE group (19.8%) [adjusted hazard ratio (aHR)=1.471, 95% CI: 1.199-1.803, P <0.001). On multivariate analysis, alpha-fetoprotein >= 5.0 ng/ml (aHR=0.202), ALBI grade >= 2 (aHR=0.709), tumor number >= 3 (aHR=0.404), and maximal tumor size >= 5 cm (aHR=0.323) were significantly associated with the lower risk of 2-year RFS in the resection group. The newly developed Surgery Risk score in BCLC-B (SR-B score) with four significant risk factors showed an area under the curve of 0.801 for the 2-year RFS and was validated. Based on the SR-B score, low-risk patients had a significantly higher 2-year RFS (training: aHR=5.834; validation: aHR=5.675) than high-risk patients (all P <0.001) did. In a PSM cohort, a low-risk resection group had a significantly higher (aHR=3.891); a high-risk resection group had a comparable 2-year RFS to those treated with TACE (aHR=0.816). Conclusions: Resection may be beneficial for resectable intermediate-stage HCC based on the SR-B score.
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