Assessment of the Surveillance Interval at 1 Year after Curative Treatment in Hepatocellular Carcinoma: Risk Stratification.
- Author:
Minjong LEE
1
;
Young CHANG
;
Sohee OH
;
Young Youn CHO
;
Dhong Eun JUNG
;
Hong Hyun KIM
;
Joon Yeul NAM
;
Hyeki CHO
;
Eun Ju CHO
;
Jeong Hoon LEE
;
Su Jong YU
;
Nam Joon YI
;
Kwang Woong LEE
;
Dong Ho LEE
;
Jeong Min LEE
;
Jung Hwan YOON
;
Kyung Suk SUH
;
Yoon Jun KIM
Author Information
- Publication Type:Original Article
- Keywords: Surveillance interval; Carcinoma, hepatocellular; Curative treatment; Risk stratification
- MeSH: Bias (Epidemiology); Carcinoma, Hepatocellular*; Cohort Studies; Humans; International Normalized Ratio; Liver Neoplasms; Recurrence; Retrospective Studies
- From:Gut and Liver 2018;12(5):571-582
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND/AIMS: Guidelines recommend surveillance for hepatocellular carcinoma (HCC) recurrence at 3-month intervals during the first year after curative treatment and 6-month intervals thereafter in all patients. This strategy does not reflect individual risk of recurrence. We aimed to stratify risk of recurrence to optimize surveillance intervals 1 year after treatment. METHODS: We retrospectively analyzed 1,316 HCC patients treated with resection/radiofrequency ablation at Barcelona Clinic Liver Cancer stage 0/ A. In patients without 1-year recurrence under 3-monthly surveillance, a new model for recurrence was developed using backward elimination methods: training (n=582)/ validation cohorts (n=291). Overall survival (OS) according to risk stratified by the new model was compared according to surveillance intervals: 3-monthly versus 6-monthly (n=401) after lead time bias correction and propensity-score matching analyses. RESULTS: Among patients without 1-year recurrence, age and international normalized ratio values were significant factors for recurrence (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.00 to 1.03; p=0.009 and HR, 5.63; 95% CI, 2.24 to 14.18; p < 0.001; respectively). High-risk patients stratified by the new model showed significantly higher recurrence rates than low-risk patients in the validation cohort (HR, 1.73; 95% CI, 1.18 to 2.53; p=0.005). After propensity-score matching between the 3-monthly and 6-monthly surveillance groups, OS in high-risk patients under 3-monthly surveillance was significantly higher than that under 6-monthly surveillance (p=0.04); however, OS in low-risk patients under 3-monthly surveillance was not significantly different from that under 6-monthly surveillance (p=0.17). CONCLUSIONS: In high-risk patients, 3-monthly surveillance can prolong survival compared to 6-monthly surveillance. However, in low-risk patients, 3-monthly surveillance might not be beneficial for survival compared to 6-monthly surveillance.
