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

Authors：Feng, Zi-Han; Wang, Ming-Da; Chen, Zhong; Sun, Li-Yang; Xu, Xiao; Kong, Qing-Yu; Chen, Zi-Xiang; Zeng, Yong-Yi; Liang, Ying-Jian; Chen, Zhi-Yu; Wang, Hong; Zhou, Ya-Hao; Chen, Ting-Hao; Yao, Lan-Qing; Li, Chao; Pawlik, Timothy M.; Lau, Wan Yee; Shen, Feng^*; Yang, Tian^*

Source：Surgery, 2022, 172(4): 1147-1155.

DOI：10.1016/j.surg.2022.05.023

• LIVER-TRANSPLANTATION
• RESECTION
• CRITERIA
• MANAGEMENT
• CIRRHOSIS
• PATTERNS
• SALVAGE
• CANCER

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.

• Institution
  安徽医科大学; 南通大学; 1; 哈尔滨医科大学