Surgical Delay Is Associated with Improved Survival in Hepatocellular Carcinoma: Results of the National Cancer Database

Xu, Kerui; Watanabe‐Galloway, Shinobu; Rochling, Fedja A.; Farazi, Paraskevi A.; Islam, K. M.; Wang, Hongmei; Luo, Jiangtao

doi:10.1007/s11605-018-3925-4

Cited by 14 publications

(34 citation statements)

References 26 publications

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“…Nevertheless, this study was criticized for the small size tumors included in the analysis (median tumor size: 3.4 cm), which were not necessarily representative of the entire spectrum of BCLC‐A tumors (i.e., large solitary tumors, or 2–3 nodules less than 3 cm) 24 . Surprisingly, by analyzing the National Cancer Database, Xu et al reported a 7% decreased hazards of death among patients who had a delayed surgery (>60 days), which was contradictory to other reports in the literature 14 . This “waiting‐time paradox” was attributed to a higher percentage of severe and aggressive cases in the early surgery group, which necessitated an early referral for surgery and, in turn resulted in worse outcomes 14 …”

Section: Discussionmentioning

confidence: 91%

“…Current guidelines offer no evidence‐based recommendations regarding the optimal “therapeutic window” from the diagnosis of HCC to definitive treatment 3 . Previous studies have reported conflicting results regarding the impact of prolonged TTS on patient outcomes 12–14 . For example, Shingal et al reported that a delay of 3 or more months from HCC diagnosis to treatment, whether it be resection, transplantation, TACE, chemotherapy or best supportive care, resulted in worse survival among HCC patients 12 .…”

Section: Discussionmentioning

confidence: 99%

“…3 Previous studies have reported conflicting results regarding the impact of prolonged TTS on patient outcomes. [12][13][14] For example, Shingal et al reported that a delay of 3 or more months from HCC diagnosis to treatment, whether it be resection, transplantation, TACE, chemotherapy or best supportive care, resulted in worse survival among HCC patients. 12 This study was, however, limited by the low number of patients who received HCC-directed therapy (n = 165); in addition, the authors analyzed patients collectively and did not provide a subgroup analysis among patients who underwent resection specifically.…”

Section: Discussionmentioning

confidence: 99%

“…To date, no robust evidence exists regarding the appropriate “therapeutic window” from the date of HCC diagnosis to the date of the necessary intervention. Of note, previous studies have reported conflicting results regarding the impact of prolonged TTS on prognosis among patients with HCC 12–14 . In addition, most studies represented single center experiences and were limited by small sample size 13,15 .…”

Section: Introductionmentioning

confidence: 99%

“…Of note, previous studies have reported conflicting results regarding the impact of prolonged TTS on prognosis among patients with HCC. [12][13][14] In addition, most studies represented single center experiences and were limited by small sample size. 13,15 Furthermore, the majority of existing studies focused entirely on patients with very early (BCLC-0) and early (BCLC-A) stage HCC.…”

Section: Introductionmentioning

confidence: 99%

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Impact of time‐to‐surgery on outcomes of patients undergoing curative‐intent liver resection for BCLC‐0, A and B hepatocellular carcinoma

Tsilimigras

Hyer

Díaz

et al. 2020

Journal of Surgical Oncology

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BackgroundThe impact of a prolonged time‐to‐surgery (TTS) among patients with resectable hepatocellular carcinoma (HCC) is not well defined.MethodsPatients who underwent curative‐intent hepatectomy for BCLC‐0, A and B HCC between 2000 and 2017 were identified using a multi‐institutional database. The impact of prolonged TTS on overall survival (OS) and disease‐free survival (DFS) was examined.ResultsAmong 775 patients who underwent resection for HCC, 537 (69.3%) had early surgery (TTS < 90 days) and 238 (30.7%) patients had a delayed surgery (TTS ≥ 90 days). Patient‐ and tumor‐related characteristics were similar between the two groups except for a higher proportion of patients undergoing major liver resection in the early surgery group (31.3% vs. 23.8%, p = .04). The percentage of patients with delayed surgery varied from 8.8% to 59.1% among different centers (p < .001). Patients with TTS < 90 days had similar 5‐year OS (63.7% vs. 64.9; p = .79) and 5‐year DFS (33.5% vs. 42.4; p = .20) with that of patients with TTS ≥ 90 days. On multivariable analysis, delayed surgery was not associated with neither worse OS (BCLC‐0/A: adjusted hazards ratio [aHR] = 0.90; 95% confidence interval [CI]: 0.65–1.25 and BCLC‐B: aHR = 0.72; 95%CI: 0.30–1.74) nor DFS (BCLC‐0/A: aHR = 0.78; 95%CI: 0.60–1.01 and BCLC‐B: aHR = 0.67; 95% CI: 0.36–1.25).ConclusionApproximately one in three patients diagnosed with resectable HCC had a prolonged TTS. Delayed surgery was not associated with worse outcomes among patients with resectable HCC.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Impact of time‐to‐surgery on outcomes of patients undergoing curative‐intent liver resection for BCLC‐0, A and B hepatocellular carcinoma

Tsilimigras

Hyer

Díaz

et al. 2020

Journal of Surgical Oncology

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Therapeutic Underuse and Delay in Hepatocellular Carcinoma: Prevalence, Associated Factors, and Clinical Impact

et al. 2021

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Prognosis of hepatocellular carcinoma (HCC) could be affected by lack of or delayed therapy. We aimed to characterize the prevalence, correlates, and clinical impact of therapeutic underuse and delay in patients with HCC. Patients with HCC diagnosed between 2010 and 2017 were analyzed from the United States National Cancer Database. Logistic regression analysis identified factors associated with no and delayed (>90 days after diagnosis) HCC treatment. Cox proportional hazards regression with landmark analysis assessed the association between therapeutic delay and overall survival (OS), accounting for immortal time bias. Of 116,299 patients with HCC, 24.2% received no treatment and 18.4% of treated patients had delayed treatment. Older age, Black, Hispanic, lower socioeconomic status, earlier year of diagnosis, treatment at nonacademic centers, Northeast region, increased medical comorbidity, worse liver dysfunction, and higher tumor burden were associated with no treatment. Among treated patients, younger age, Hispanic, Black, treatment at academic centers, West region, earlier tumor stage, and receipt of noncurative treatment were associated with treatment delays. In multivariable Cox regression with a landmark of 150 days, patients with and without treatment delays had similar OS (adjusted hazard ratio [aHR], 1.01; 95% confidence interval [CI], 0.98-1.04) with a median survival of 33.7 vs. 32.1 months, respectively. However, therapeutic delay was associated with worse OS in patients who had tumor, nodes, and metastases (TNM) stage 1 (aHR, 1.06; 95% CI, 1.01-1.11) or received curative treatment (aHR, 1.12; 95% CI, 1.05-1.18). Conclusion: One-fourth of patients with HCC receive no therapy and one-fifth of treated patients experience treatment delays. Both were associated with demographic, socioeconomic, and clinical characteristics of patients as well as facility type and region. The association between therapeutic delay and survival was stage and treatment dependent. (Hepatology Communications 2021;0:1-14).

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Effect of surgical delay on survival outcomes in patients undergoing curative resection for primary hepatocellular carcinoma: Inverse probability of treatment weighting using propensity scores and propensity score adjustment

Kabir

Syn

Ramkumar

et al. 2020

Surgery

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Surgical Delay Is Associated with Improved Survival in Hepatocellular Carcinoma: Results of the National Cancer Database

Cited by 14 publications

References 26 publications

Impact of time‐to‐surgery on outcomes of patients undergoing curative‐intent liver resection for BCLC‐0, A and B hepatocellular carcinoma

Impact of time‐to‐surgery on outcomes of patients undergoing curative‐intent liver resection for BCLC‐0, A and B hepatocellular carcinoma

Therapeutic Underuse and Delay in Hepatocellular Carcinoma: Prevalence, Associated Factors, and Clinical Impact

Effect of surgical delay on survival outcomes in patients undergoing curative resection for primary hepatocellular carcinoma: Inverse probability of treatment weighting using propensity scores and propensity score adjustment

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