Impact of time to surgery in the outcome of patients with liver resection for BCLC 0-A stage hepatocellular carcinoma
Impact of time to surgery in the outcome of patients with liver resection for BCLC 0-A stage hepatocellular carcinoma
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DOI：
10.1016/j.jhep.2017.09.017
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发表时间：
2018-01-01
影响因子：
25.7
通讯作者：
Azoulay, Daniel
中科院分区：
文献类型：
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作者：
Lim, Chetana;Bhangui, Prashant;Azoulay, Daniel
背景和目标：巴塞罗那临床肝癌（BCLC）指南建议对极早期和早期单一肝细胞癌（HCC）患者进行切除。目前尚不清楚从诊断时间（手术时间[TTS]，即从诊断到手术的时间）开始的切除延迟是否会影响结局。我们的目的是评估TTS对HCC患者复发和生存结局的影响。方法：研究了2006年至2016年因BCLC 0-A期单一HCC切除的所有患者，以评估TTS对复发率、无复发生存期（RFS）、复发后可移植性和意向治疗总生存期（ITT-OS）的影响。进一步进行倾向评分匹配（PSM），以确保可比性。在诊断后0.6至77个月之间进行手术（中位TTS：3个月;四分位距：1.8-4.6个月）。无术后死亡。与TTS < 3个月的患者相比，TTS >= 3个月的患者（70%的患者TTS 3-6个月）术后发病率较高，（36% vs. 16%，p = 0.02），相似的肿瘤复发率（32% vs. 32%，p = 1.00），RFS（37% vs. 48%，p = 0.42）、肿瘤复发后的移植性（63% vs. 50%，p = 0.48）和5年ITT-OS（82% vs. 80%，p = 0.20）。PSM后观察到类似的结果。结论：BCLC 0-A期单一HCC患者可以接受手术，TTS = 3个月，而不会损害肿瘤学结局。TTS在安全范围内的增加可以为手术前的适当评估留出时间，并对新的新辅助治疗进行伦理测试，旨在降低尽管进行了根治性切除术但肿瘤复发率仍然很高。符合欧洲肝病研究协会要求的HCC患者诊断后至切除时间延迟≥ 3个月/与手术延迟< 3个月的患者相比，美国肝病研究协会的切除标准不影响肿瘤学和长期结局。(C)2017年欧洲肝脏研究协会。Elsevier B. V.出版，保留所有权利。
Background & Aims: The Barcelona Clinic Liver Cancer (BCLC) guidelines recommend resection for very early and early single hepatocellular carcinoma (HCC) patients. It is not known whether a delay in resection from the time of diagnosis (the time to surgery [TTS], i.e. the elapsed time from diagnosis to surgery) affects outcomes. We aim to evaluate the impact of TTS on recurrence and survival outcomes in patients with HCC.Methods: All patients resected for BCLC stage 0-A single HCC from 2006 to 2016 were studied to evaluate the impact of TTS on recurrence rate, recurrence-free survival (RFS), transplantability following recurrence, and intention-to-treat overall survival (ITT-OS). Propensity score matching (PSM) was further performed to ensure comparability.Results: The study population included 100 patients. Surgery was performed between 0.6 and 77 months after diagnosis (median TTS: three months; interquartile range: 1.8-4.6 mont hs). There was no post-operative mortality. Compared to those with TTS < 3 months, patients with TTS >= 3 months (70% of these patients had TTS 3-6 months) had a higher post-operative morbidity (36% vs. 16%, p = 0.02), a similar tumor recurrence rate (32% vs. 32%, p = 1.00), RFS (37% vs. 48%, p = 0.42), transplantability following tumor recurrence (63% vs. 50%, p = 0.48), and five-year ITT-OS (82% vs. 80%, p = 0.20). Similar results were observed after PSM.Conclusion: Patients with BCLC stage 0-A single HCC can undergo surgery with TTS = 3 months without impaired oncologic outcomes. An increase in the TTS within a safe range could allow time for proper evaluation before surgery, and ethical testing of new neoadjuvant treatments, aiming to reduce the high rate of tumor recurrence despite curative resection.Lay summary: A delay of = 3 months in time to resection after diagnosis in HCC patients meeting the European Association for the Study of Liver Disease/American Association for the Study of Liver Disease criteria for resection does not affect oncological and long-term outcomes compared to those with a delay to surgery of < 3 months. (C) 2017 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.