Factors predicting long-term outcomes of early-stage hepatocellular carcinoma after primary curative treatment: the role of surgical or nonsurgical methods

Abstract

Background We quantified the elusive effects of putative factors on the clinical course of early hepatocellular carcinoma (HCC) after primary surgical or nonsurgical curative treatment. Methods Patients with newly diagnosed early HCC who received surgical resection (SR) or percutaneous radiofrequency ablation (RFA) with or without transcatheter arterial chemoembolization (TACE) from January 2003 to December 2016 were enrolled. The cumulative overall survival (OS) and disease-free survival (DFS) rates were compared. A polytomous logistic regression was used to estimate factors for early and late recurrence. Independent predictors of OS were identified using Cox proportional hazard regression. Results One hundred twenty-five patients underwent SR, and 176 patients underwent RFA, of whom 72 were treated with TACE followed by RFA. Neither match analysis based on propensity score nor multiple adjustment regression yielded a significant difference in DFS and OS between the two groups. Multivariate analysis showed high AFP (> 20 ng/mL), and multinodularity significantly increased risk of early recurrence (< 1 year). In contrast, hepatitis B virus, hepatitis C virus and multinodularity were significantly associated with late recurrence (> 1 year). Multivariate Cox regression with recurrent events as time-varying covariates identified older age (HR = 1.55, 95% CI:1.01–2.36), clinically significant portal hypertension (CSPH) (HR = 1.97, 95% CI:1.26–3.08), early recurrence (HR = 6.62, 95% CI:3.79–11.6) and late recurrence (HR = 3.75, 95% CI:1.99–7.08) as independent risk factors of mortality. A simple risk score showed fair calibration and discrimination in early HCC patients after primary curative treatment. In the Barcelona Clinic Liver Cancer (BCLC) stage A subgroup, SR significantly improved DFS compared to RFA with or without TACE. Conclusion Host and tumor factors rather than the initial treatment modalities determine the outcomes of early HCC after primary curative treatment. Statistical models based on recurrence types can predict early HCC prognosis but further external validation is necessary.

Predictors of Hepatocellular Carcinoma Early Recurrence in Patients Treated with Surgical Resection or Ablation Treatment: A Single-Center Experience

“…1.12–1.63) for early recurrence after curative treatment. Nevertheless, other studies did not report any significant difference in early, gender-related HCC recurrence [ 50 , 51 , 52 ]. Despite no precise data, it can be assumed that the same hormonal factors promoting tumorigenesis might induce even HCC recurrence.…”

Clinical Nursing Paths Benefit Patient Outcomes Undergoing Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma

“…It is possible to cure the disease in the early stage, the treatment in the middle and late stage is relatively complex, and the efficacy in the early stage of intersection is quite different [ 4 ]. At the moment, an interventional therapy is a nonsurgical method and the first choice for advanced HCC patients [ 5 ]. Embolic agents and anticancer drugs are injected into the hepatic artery through femoral artery intubation to achieve the efficacy.…”

Transarterial Chemoembolization Combined With Radiofrequency Ablation Versus Hepatectomy for Hepatocellular Carcinoma: A Meta-Analysis

“…In the retrospective study of 132 HCC patients who received TACE + RFA, tumor size, combined portal venous collateral circulation, alpha-fetoprotein, total bilirubin, and Child–Pugh grade are found to be independent risk factors that affect OS and the overall coexistence rate ( 31 ). According to the current literature, the main complication after TACE + RFA is embolism syndrome, while other serious complications include perforation of the gallbladder, skin burns, ectopic embolism, diaphragmatic fistula, intestinal necrosis, liver failure, intraperitoneal bleeding, and renal failure wait ( 10 , 32 ).…”