Moazzam Zorays, Lima Henrique A, Alaimo Laura, Endo Yutaka, Shaikh Chanza F, Ratti Francesca, Marques Hugo P, Soubrane Olivier, Lam Vincent, Poultsides George A, Popescu Irinel, Alexandrescu Sorin, Martel Guillaume, Guglielmi Alfredo, Hugh Tom, Aldrighetti Luca, Endo Itaru, Pawlik Timothy M
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH. Electronic address: http://www.twitter.com/ZoraysM.
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
Surgery. 2022 Nov;172(5):1448-1455. doi: 10.1016/j.surg.2022.07.019. Epub 2022 Aug 26.
The ability to predict the incidence, timing, and site of recurrence can be beneficial to select surgical candidates and inform appropriate postoperative surveillance. We sought to identify factors associated with risk and timing of recurrence after resection of hepatocellular carcinoma based on differences in tumor burden score.
Patients who underwent curative-intent liver resection for hepatocellular carcinoma between 2000 and 2020 were identified from an international multi-institutional database. The incidence, timing, and pattern of recurrence was examined relative to traditional clinicopathological factors, as well as tumor burden score using hazard rates and multivariable analysis.
Among 1,994 patients (tumor burden score, low: n = 511, 25.6% vs medium: n = 1,286, 64.5% vs high: n = 197, 9.9%), the incidence of recurrence at 5 years was 50.4% (95% confidence interval 47.9-53.0); risk of recurrence varied relative to hepatocellular carcinoma tumor burden score (low: 36.0% vs medium: 54.4% vs high: 62.5%, P < .001). Although intrahepatic recurrence was much more common in low tumor burden score (low: n = 106, 84.1% vs medium: n = 335, 71.7% vs high: n = 48, 56.5%; P < .001), extrahepatic recurrence was more common in high tumor burden score (low: n = 18, 14.3% vs medium: n = 121, 25.9% vs high: n = 37, 43.5%; P < .001). The peak hazard rate for intrahepatic recurrence among patients with a high tumor burden score was almost double the peak hazard noted among patients with a low tumor burden score (low: 0.047, 42.0 months vs medium: 0.051, 6.6 months vs high: 0.094, 15.0 months). Of note, the patients with high tumor burden score were also more likely to recur earlier (≤24 months) (low: n = 227, 44.4% vs medium: n = 686, 53.3% vs high: n = 144, 73.1%) with multiple tumors (low: n = 50, 36.5% vs medium: n = 271, 56.1% vs high: n = 52, 70.3%) and larger lesions (low: 1.8 [interquartile range 1.2-3.0] cm vs medium: 2.0 [interquartile range 1.3-3.0] cm vs high: 2.5 [interquartile range 1.6-4.4] cm) (all P < .001). On multivariable analysis, high tumor burden score remained independently associated with risk of recurrence (referent, low; medium: hazard ratio = 1.49 [95% confidence interval 1.19-1.88], P = .001; high: hazard ratio = 1.95 [95% confidence interval 1.41-2.69]; P < .001].
Tumor burden score was independently associated with higher risk of recurrence. Patients who underwent resection of high tumor burden score lesions were more likely to recur early with multiple tumors and at an extrahepatic site. Tumor burden score is an important tool in assessing risk, timing, and pattern of recurrence after resection of hepatocellular carcinoma.
预测复发的发生率、时间和部位的能力有助于选择手术候选者并指导适当的术后监测。我们试图基于肿瘤负荷评分的差异，确定肝细胞癌切除术后复发风险和时间的相关因素。
从一个国际多机构数据库中识别出2000年至2020年间接受肝细胞癌根治性肝切除术的患者。相对于传统的临床病理因素以及使用风险率和多变量分析的肿瘤负荷评分，检查复发的发生率、时间和模式。
在1994例患者中（肿瘤负荷评分，低：n = 511，25.6%；中：n = 1286，64.5%；高：n = 197，9.9%），5年复发率为50.4%（95%置信区间47.9 - 53.0）；复发风险因肝细胞癌肿瘤负荷评分而异（低：36.0%；中：54.4%；高：62.5%，P <.001）。尽管肝内复发在低肿瘤负荷评分患者中更为常见（低：n = 106，84.1%；中：n = 335，71.7%；高：n = 48，56.5%；P <.001），但肝外复发在高肿瘤负荷评分患者中更为常见（低：n = 18，14.3%；中：n = 121，25.9%；高：n = 37，43.5%；P <.001）。高肿瘤负荷评分患者肝内复发的风险率峰值几乎是低肿瘤负荷评分患者的两倍（低：0.047，42.0个月；中：0.051，6.6个月；高：0.094，15.0个月）。值得注意的是，高肿瘤负荷评分的患者也更有可能早期复发（≤24个月）（低：n = 227，44.4%；中：n = 686，53.3%；高：n = 144，73.1%），伴有多发肿瘤（低：n = 50，36.5%；中：n = 271，56.1%；高：n = 52，70.3%）和更大的病灶（低：1.8 [四分位间距1.2 - 3.0] cm；中：2.0 [四分位间距1.3 - 3.0] cm；高：2.5 [四分位间距1.6 - 4.4] cm）（所有P <.001）。多变量分析显示，高肿瘤负荷评分仍与复发风险独立相关（参照，低；中：风险比 = 1.49 [95%置信区间1.19 - 1.88]，P =.001；高：风险比 = 1.95 [95%置信区间1.41 - 2.69]；P <.00！）。
肿瘤负荷评分与较高的复发风险独立相关。接受高肿瘤负荷评分病灶切除术的患者更有可能早期复发，伴有多发肿瘤且为肝外部位复发。肿瘤负荷评分是评估肝细胞癌切除术后复发风险、时间和模式的重要工具。
