Lim Chetana, Bhangui Prashant, Salloum Chady, Gómez-Gavara Concepción, Lahat Eylon, Luciani Alain, Compagnon Philippe, Calderaro Julien, Feray Cyrille, Azoulay Daniel
Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France.
Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, New Delhi, India.
J Hepatol. 2017 Oct 6. doi: 10.1016/j.jhep.2017.09.017.
BACKGROUND & AIMS: The Barcelona Clinic Liver Cancer (BCLC) guidelines recommend resection for very early and early single hepatocellular carcinoma (HCC) patients. It is not known whether a delay in resection from the time of diagnosis (the time to surgery [TTS], i.e. the elapsed time from diagnosis to surgery) affects outcomes. We aim to evaluate the impact of TTS on recurrence and survival outcomes in patients with HCC.
All patients resected for BCLC stage 0-A single HCC from 2006 to 2016 were studied to evaluate the impact of TTS on recurrence rate, recurrence-free survival (RFS), transplantability following recurrence, and intention-to-treat overall survival (ITT-OS). Propensity score matching (PSM) was further performed to ensure comparability.
The study population included 100 patients. Surgery was performed between 0.6 and 77 months after diagnosis (median TTS: three months; interquartile range: 1.8-4.6 months). There was no post-operative mortality. Compared to those with TTS <3 months, patients with TTS ≥3 months (70% of these patients had TTS 3-6 months) had a higher post-operative morbidity (36% vs. 16%, p = 0.02), a similar tumor recurrence rate (32% vs. 32%, p = 1.00), RFS (37% vs. 48%, p = 0.42), transplantability following tumor recurrence (63% vs. 50%, p = 0.48), and five-year ITT-OS (82% vs. 80%, p = 0.20). Similar results were observed after PSM.
Patients with BCLC stage 0-A single HCC can undergo surgery with TTS ≥3 months without impaired oncologic outcomes. An increase in the TTS within a safe range could allow time for proper evaluation before surgery, and ethical testing of new neoadjuvant treatments, aiming to reduce the high rate of tumor recurrence despite curative resection.
A delay of ≥3 months in time to resection after diagnosis in HCC patients meeting the European Association for the Study of Liver Disease/American Association for the Study of Liver Disease criteria for resection does not affect oncological and long-term outcomes compared to those with a delay to surgery of <3 months.
巴塞罗那临床肝癌（BCLC）指南推荐对极早期和早期单发性肝细胞癌（HCC）患者进行手术切除。从诊断时起延迟手术切除（手术时间 [TTS]，即从诊断到手术的时间间隔）是否会影响预后尚不清楚。我们旨在评估 TTS 对 HCC 患者复发和生存预后的影响。
研究了 2006 年至 2016 年期间因 BCLC 0 - A 期单发性 HCC 接受手术切除的所有患者，以评估 TTS 对复发率、无复发生存期（RFS）、复发后的移植可能性以及意向性治疗总生存期（ITT - OS）的影响。进一步进行倾向评分匹配（PSM）以确保可比性。
研究人群包括 100 例患者。手术在诊断后 0.6 至 77 个月之间进行（中位 TTS：3 个月；四分位间距：1.8 - 4.6 个月）。无术后死亡病例。与 TTS <3 个月的患者相比，TTS≥3 个月的患者（其中 70%的患者 TTS 为 3 - 6 个月）术后发病率更高（36% 对 16%，p = 0.02），肿瘤复发率相似（32% 对 32%，p = 1.00），RFS（37% 对 48%，p = 0.42），肿瘤复发后的移植可能性（63% 对 50%，p = 0.48）以及五年 ITT - OS（82% 对 80%，p = 0.20）。PSM 后观察到类似结果。
BCLC 0 - A 期单发性 HCC 患者 TTS≥3 个月时可进行手术，且肿瘤学预后不受影响。在安全范围内延长 TTS 可为手术前的适当评估以及新辅助治疗的伦理测试留出时间，旨在降低尽管进行了根治性切除但肿瘤复发率仍较高的问题。
符合欧洲肝脏研究协会/美国肝脏研究协会切除标准的 HCC 患者，诊断后手术切除延迟≥3 个月与延迟<3 个月的患者相比，不影响肿瘤学和长期预后。
