Six months as a cutoff time point to define early recurrence after liver resection of hepatocellular carcinoma based on
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ORIGINAL ARTICLE
Six months as a cutoff time point to define early recurrence after liver resection of hepatocellular carcinoma based on post‑recurrence survival Yueh‑Wei Liu1 · Chee‑Chien Yong1 · Chih‑Che Lin1 · Chih‑Chi Wang1 · Chao‑Long Chen1 · Yu‑Fan Cheng2 · Jing‑Houng Wang3 · Yi‑Hao Yen3 Received: 1 September 2020 / Accepted: 11 November 2020 © Italian Society of Surgery (SIC) 2020
Abstract To determine the optimal cutoff time point of early versus late recurrence relative to post-recurrence survival (PRS) among patients who underwent liver resection (LR) for hepatocellular carcinoma (HCC) in a high-volume liver surgery center in East Asia. This was a retrospective study. Patients who underwent LR for HCC between 2011 and 2018 at Kaohsiung Chang Gung Memorial Hospital were enrolled. The optimal cutoff time point to differentiate early versus late recurrence was evaluated relative to PRS. Among 826 patients, 282 (34.1%) of the patients experienced recurrence, with a median time to recurrence of 12.2 months. 6 months was defined as the optimal cutoff time point based on sensitivity analyses relative to PRS. Ninety (31.9%) of the patients developed early recurrence within 6 months, and 192 patients (68.1%) developed late recurrence beyond 6 months. Early recurrence was associated with worse PRS (median PRS, 13.2 versus 48.9 months, p 1.2
14 (15.6%)
44 (22.9%)
Yes
48 (53.3%)
90 (46.9%)
No
41 (45.6%)
102 (53.1%)
Major
57 (63.3%)
102 (53.1%)
Minor
33 (36.7%)
90 (46.9%)
Well or moderate
80 (88.9%)
181 (94.3%)
Poor
9 (10%)
10 (5.2%)
Unknown
1 (1.1%)
1 (0.5%)
44.5 (24.3–64.5)
35 (24.3–64.5)
0, A
45 (50%)
135 (70.3%)
B, C, D
41 (45.6%)
52 (27.1%)
Unknown
4 (4.4%)
5 (2.6%)
Smoking
0.63 0.96
Alcohol use disorder
1.00
HBsAg
0.23
Anti-HCV
0.53
Child–Pugh class
0.44
AFP (ng/ml)
400 vs. ≤ 400 Cirrhosis, yes vs. no Tumor differentiation, poor vs. well/moderate Tumor size (mm) > 50 vs. ≤ 50 Pathology T stage, 3 or 4 vs. 1 or 2 BMI (kg/m2), > 27 vs. ≤ 27 Smoking, yes vs. no Alcohol use disorder, yes vs. no HBsAg, positive vs. negative Anti-HCV, positive vs. negative Child–Pugh class, B vs. A INR, > 1.3 vs. ≤ 1.3 Total bilirubin (mg/dl), > 2.0 vs. ≤ 2.0 Creatinine (mg/dl), > 1.2 vs. ≤ 1.2 Type of resection, major vs. minor Late recurrence beyond 6 months Age (years), > 65 vs. ≤ 65 Male vs. female AFP (ng/ml), > 400 vs. ≤ 400 Cirrhosis, yes vs. no Tumor differentiation, poor vs. well/moderate Tumor size (mm), > 50 vs. ≤ 50 Pathology T stage, 3 or 4 vs. 1 or 2 BMI (kg/m2), > 27 vs. ≤ 27 Smoking, yes vs. no Alcohol use disorder, yes vs. no HBsAg, positive vs. negative Anti-HCV, positive vs. negative Child–Pugh class, B vs. A INR > 1.3 vs. ≤ 1.3 Total bilirubin (mg/dl) > 2.0 vs. ≤ 2.0 Creatinine (mg/dl) > 1.2 vs. ≤ 1.2 Type of resection, major vs. minor
0.91 (0.56–1.45) 0.81 (0.49–1.37) 3.74 (2.25–6.16) 1.99 (1.27–3.14) 3.64 (1.50–8.37) 2.68 (1.69–4.25) 5.60 (3.33–9.37) 1.05 (0.62–1.73) 1.20 (0.74–1.92) 0.87 (0.35–1.87) 1.42 (0.91–2.26) 1.2
