Akabane Miho, Kawashima Jun, Woldesenbet Selamawit, Altaf Abdullah, Cauchy François, Aucejo Federico, Popescu Irinel, Kitago Minoru, Martel Guillaume, Ratti Francesca, Aldrighetti Luca, Poultsides George A, Imaoka Yuki, Ruzzenente Andrea, Endo Itaru, Gleisner Ana, Marques Hugo P, Lam Vincent, Hugh Tom, Bhimani Nazim, Shen Feng, Pawlik Timothy M
Department of Surgery, The Ohio State University Wexner Medical Center and The James Comprehensive Cancer Center, Columbus, OH, United States.
Department of Hepatobiliopancreatic Surgery, Assistance Publique-Hôpitaux de Paris, Beaujon Hospital, Clichy, France.
J Gastrointest Surg. 2025 Feb;29(2):101903. doi: 10.1016/j.gassur.2024.101903. Epub 2024 Nov 27.
The effect of "time to surgery (TTS)" on outcomes for curative-intent hepatectomy of hepatocellular carcinoma (HCC) remains debated. The interaction between tumor burden score (TBS) and TTS remains unclear. We sought to evaluate the effects of TBS and TTS on long-term HCC outcomes.
Patients with HCC who underwent curative-intent hepatectomy (2000-2022) were analyzed from a multi-institutional database and categorized by TTS (≤60 or >60 days). Overall survival (OS) and cancer-specific survival were assessed.
Among 910 patients, median TTS estimates were 22 days in the short TTS group (n = 485) and 120 days in the long TTS group (n = 425). Patients with long TTS were older and were more likely to have American Society of Anesthesiologists class >2, diabetes mellitus, and cirrhosis. There was no difference in median TBS among patients who had short versus long TTS (4.61 vs 5.00, respectively). In addition, there was no difference in 5-year OS (70.0% vs 63.1%, respectively; P =.05). On multivariate analysis TBS (hazard ratio [HR], 1.07; 95% CI, 1.03-1.11; P <.001), log alpha-fetoprotein (HR, 1.08; 95% CI, 1.01-1.14; P =.02), and albumin-bilirubin score (HR, 2.52; 95% CI, 1.66-3.82; P <.001) were associated with OS. In contrast, TTS was not associated with OS (HR, 1.18; 95% CI, 0.78-1.77; P =.43). Interaction analysis demonstrated that TBS was asssociated with OS among patients with short TTS (HR, 1.12; 95% CI, 1.07-1.17; P <.001), but not among patients with long TTS (HR, 0.98; 95% CI, 0.91-1.05; P =.56). Among patients with low TBS (≤5), higher mortality was observed with long TTS versus short TTS (5-year OS: 82.4% vs 63.0%, respectively; P =.001); however, TTS was not associated with OS among patients with high TBS (5-year OS: 57.9% vs 63.3%, respectively; P =.92). Multivariate analysis demonstrated that long TTS was a risk factor for OS among patients with low TBS (HR, 3.12; 95% CI, 1.60-6.01; P <.001), but not among individuals with high TBS (HR, 0.57; 95% CI, 0.30-1.07; P =.08). Similar trends were observed relative to cancer-specific survival.
TTS needs to be considered in light of patient and tumor-specific factors. Expediting TTS may be particularly important among patients with HCC and a low TBS.
“手术时机（TTS）”对肝细胞癌（HCC）根治性肝切除术预后的影响仍存在争议。肿瘤负荷评分（TBS）与TTS之间的相互作用尚不清楚。我们试图评估TBS和TTS对HCC长期预后的影响。
从一个多机构数据库中分析2000年至2022年期间接受根治性肝切除术的HCC患者，并按TTS（≤60天或>60天）进行分类。评估总生存期（OS）和癌症特异性生存期。
在910例患者中，短TTS组（n = 485）的TTS中位数估计为22天，长TTS组（n = 425）为120天。长TTS患者年龄较大，更有可能美国麻醉医师协会分级>2级、患有糖尿病和肝硬化。短TTS患者与长TTS患者的TBS中位数无差异（分别为4.61和5.00）。此外，5年OS无差异（分别为70.0%和63.1%；P = 0.05）。多因素分析显示，TBS（风险比[HR]，1.07；95%置信区间[CI]，1.03 - 1.11；P < 0.001）、甲胎蛋白对数（HR，1.08；95% CI，1.01 - 1.14；P = 0.02）和白蛋白 - 胆红素评分（HR，2.52；95% CI，1.66 - 3.82；P < 0.001）与OS相关。相比之下，TTS与OS无关（HR，1.18；95% CI，0.78 - 1.77；P = 0.43）。交互分析表明，TBS与短TTS患者的OS相关（HR，1.12；95% CI，1.07 - 1.17；P < 0.001），但与长TTS患者无关（HR，0.98；95% CI，0.91 - 1.05；P = 0.56）。在低TBS（≤5）患者中，长TTS患者的死亡率高于短TTS患者（5年OS：分别为82.4%和63.0%；P = 0.001）；然而，高TBS患者中TTS与OS无关（5年OS：分别为57.9%和63.3%；P = 0.92）。多因素分析表明，长TTS是低TBS患者OS的危险因素（HR，3.12；95% CI，1.60 - 6.01；P < 0.001），但不是高TBS患者的危险因素（HR，0.57；95% CI，0.30 - 1.07；P = 0.08）。在癌症特异性生存方面也观察到类似趋势。
需要根据患者和肿瘤特异性因素来考虑TTS。对于HCC和低TBS患者，加快TTS可能尤为重要。
