Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
J Gastrointest Surg. 2021 Jan;25(1):125-133. doi: 10.1007/s11605-020-04553-2. Epub 2020 Mar 3.
To define early versus late recurrence based on post-recurrence survival (PRS) among patients undergoing curative resection for hepatocellular carcinoma (HCC).
Patients who underwent curative-intent resection for HCC between 2000 and 2017 were identified from an international multi-institutional database. The optimal cut-off time point to discriminate early versus late recurrence was determined relative to PRS.
Among 1004 patients, 443 (44.1%) patients experienced recurrence with a median recurrence-free survival time of 12 months. A cut-off time point of 8 months was defined as the optimal threshold based on sensitivity analyses relative to PRS for early (n = 165, 37.2%) versus late relapse (n = 278, 62.8%) (p = 0.008). Early recurrence was associated with worse PRS (median PRS, 27.0 vs. 43.0 months, p = 0.019), as well as overall survival (OS) (median OS, 32.0 versus 74.0 months, p < 0.001) versus late recurrence. In addition, patients who recurred early were more likely to recur at extra- ± intrahepatic (35.5% vs. 19.8%, p = 0.003) sites and were less likely to have the recurrence treated with curative intent (33.8% vs. 45.7%, p = 0.08). Patients undergoing curative re-treatment of late recurrence had a comparable OS with patients who had no recurrence (median OS, 139.0 vs. 140.0 months); patients with early recurrence had inferior OS after curative re-treatment versus patients with no recurrence (median OS, 69.0 vs. 140.0 months, p = 0.036), yet still better than patients who received palliative treatment for early recurrence (median OS, 69.0 vs. 21.0 months, p < 0.001).
Eight months was identified as the cut-off value to differentiate early versus late recurrence. Curative-intent treatment for recurrent intrahepatic tumors was associated with reasonable long-term outcomes.
本研究旨在基于肝癌患者根治性切除术后的无复发生存期（recurrence-free survival，PRS）定义早期和晚期复发。
本研究从一个国际多机构数据库中筛选出 2000 年至 2017 年间接受根治性切除术治疗的肝癌患者。通过相对 PRS 确定区分早期和晚期复发的最佳截断时间点。
在 1004 例患者中，443 例（44.1%）患者发生了复发，中位无复发生存时间为 12 个月。基于对 PRS 的敏感性分析，将 8 个月定义为早期（n=165，37.2%）和晚期（n=278，62.8%）复发的最佳截断阈值（p=0.008）。早期复发与更差的 PRS（中位 PRS，27.0 个月 vs. 43.0 个月，p=0.019）和总生存（OS）（中位 OS，32.0 个月 vs. 74.0 个月，p<0.001）相关，而晚期复发则与之相反。此外，早期复发的患者更有可能在肝内和肝外（35.5% vs. 19.8%，p=0.003）部位复发，且更不可能通过根治性治疗来处理复发（33.8% vs. 45.7%，p=0.08）。接受晚期复发根治性再治疗的患者的 OS 与未复发的患者相当（中位 OS，139.0 个月 vs. 140.0 个月）；接受根治性再治疗的早期复发患者的 OS 比未复发的患者差（中位 OS，69.0 个月 vs. 140.0 个月，p=0.036），但仍优于接受早期复发姑息性治疗的患者（中位 OS，69.0 个月 vs. 21.0 个月，p<0.001）。
本研究确定 8 个月为区分早期和晚期复发的截断值。对复发性肝内肿瘤进行根治性治疗可获得合理的长期结局。
