Abstract
Purpose: There is a lack of consensus on the surveillance strategy for Barcelona Clinic liver cancer (BCLC) stage B hepatocellular carcinoma (HCC) patients with complete remission (CR). We performed a real-world, retrospective analysis of the surveillance strategy for BCLC stage B HCC patients after radical therapy with CR to support clinical decision-making.Materials and Methods: We analyzed 546 BCLC stage B HCC patients with CR after radical treatments (surgery/ablation) at Sun Yat-sen University Cancer Center, from January 2007 to December 2019. The intensity of surveillance interval was defined as the mean of surveillance interval within 2 years. The primary endpoint of the study was overall survival (OS) and extra-Milan criteria relapse.Results: During a median follow-up time of 23.9 months (range = 3.1–148.3 months), there were 11.9% of patients died, 56.6% of patients developed recurrence, the vast majority of patients experienced recurrence within 2 years, and 27.8% patients developed extra-Milan criteria recurrence. The median disease-free survival and OS were 33.6 and 60.0 months, respectively. Patients were divided into regular surveillance group (RS) (≤4.3 months) and irregular surveillance (IRS) group (>4.3 months) based on the optimal cutoff value of the intensity of surveillance interval. The RS group owned a lower incident of extra-Milan criteria relapse and smaller and fewer tumors at recurrence than IRS group, which contributed to the prolonged OS. Besides, the cutoff values of surveillance interval that could lead to significant differences in the incidence of extra-Milan criteria relapse during 0–6, 6–12, and 12–18 months after CR were 2.6, 2.9, and 3 months, respectively.Conclusions: The average surveillance interval for patients with BCLC stage B HCC achieved CR should not exceed 4.3 months during the first 2 years' follow-up. During three different phases of the initial 18 months after CR, individualized surveillance showed intervals no more than 3 months were required to reduce the incidence of extra-Milan criteria relapse.
Highlights
Hepatocellular carcinoma (HCC) is the sixth most commonly diagnosed cancer and the fourth leading cause of cancer death worldwide in 2018 [1]
The number of patients with HCC originating from hepatitis C virus (HCV) has increased year by year, and the number of HCC patients owing to Hepatitis B virus (HBV) has decreased [3]
In the further analysis of patients with extra-Milan criteria relapse in 0–18 months, we found that the regular surveillance group (RS) group could earlier detect extra-Milan criteria relapse (P = 0.046, hazard ratio (HR) = 0.602, 95% confidence interval (CI) = 0.366–0.991) (Figure 6B), which significantly prolonged Overall survival (OS) (P < 0.001, HR = 2.893, 95% CI = 1.647–5.082) (Figure 6A)
Summary
Hepatocellular carcinoma (HCC) is the sixth most commonly diagnosed cancer and the fourth leading cause of cancer death worldwide in 2018 [1]. Rates of both incidence and mortality are two to three times higher among men in most regions [1]. Hepatitis B virus (HBV) and hepatitis C virus (HCV) are considered to be the main pathogens for the development of HCC, especially in Asia [2]. The Barcelona Clinic liver cancer (BCLC) stage B (intermediate stage) [4] patients account for ∼19.4% of total HCC [5]. The main factors were the span of liver function score (Child–Pugh: 5–9), the difference of tumor size (diameter 3–10 cm or more), tumor number (2–20 or more), and the difference of tumor distribution (single lobe limited or double lobe diffused)
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