Postoperative HCC recurrence surveillance should target the liver
medwireNews: Clinicians monitoring patients for late recurrence after curative surgery for hepatocellular carcinoma (HCC) should focus on the liver, say Chinese researchers who found few patients develop only extrahepatic disease in the first instance.
Tian Yang, from Second Military Medical University in Shanghai, and co-workers report that 41.3% of 734 patients who were free from disease for the first 2 years after HCC resection subsequently experienced a late recurrence.
For the majority (90.1%) of the patients who experienced late recurrence, disease was limited to the liver, while 9.9% had both intrahepatic and extrahepatic disease.
As there were no isolated cases of late recurrence outside of the liver, the investigators believe that “screening for extrahepatic metastasis using chest CT [computed tomography] and skeletal emission [CT] after 2 years of surgery is unnecessary” unless intrahepatic recurrence has been identified.
As reported in JAMA Surgery, multivariate analysis indicated that recurrence in patients who were free from disease for at least 2 years after surgery was a significant 1.372 times more common in men than women.
Late recurrence was also significantly and independently predicted by macroscopic (hazard ratio [HR]=4.631) and microscopic (HR=1.686) vascular invasion; multiple tumours (HR=1.559); satellite nodules (HR=1.587); a tumour larger than 5 cm (HR=1.487) and cirrhosis (HR=1.421).
Altogether, 54.5% of the patients with late recurrence were able to undergo potentially curative treatment, such as resection, transplantation or local ablation.
Multivariate Cox regression analysis for overall survival demonstrated that the risk of death after late recurrence was significantly reduced for patients who had undergone regular surveillance after surgery (HR=0.470) and who received potentially curative treatment (HR=0.443).
“Regular surveillance improved the chance of patients to undergo potentially curative treatment at the time of diagnosis of late recurrence of HCC, thus contributing to better survival for these patients”, write Tian Yang et al.
By contrast, the likelihood of death was significantly higher for patients with Barcelona Clinic Liver Cancer stage B (HR=1.304) and C (HR=2.037) disease, or Child-Pugh grade B or C disease (HR=1.376) than those with earlier stage disease. Patients with portal hypertension (HR=2.424) or cirrhosis (HR=1.381) were also at increased risk of dying compared with those without.
“The current guidelines on HCC recurrence surveillance can be improved, and an individualized surveillance strategy should take account of the time from surgery and the patterns of recurrent tumor”, the authors conclude.
“This strategy is more cost-effective and provides a better balance between the benefit obtained from tumor surveillance and medical expenditure.”
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