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Preoperative predictors of non-transplantable recurrence after resection for early-stage hepatocellular carcinoma: application in an East Asian cohort

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Abstract

A French study found that three preoperative factors (i.e. alpha-fetoprotein (AFP) > 100 ng/ml, image-diagnosed tumor number > 1, and cirrhosis) could predict non-transplantable recurrence (NTR) after liver resection (LR) for early-stage hepatocellular carcinoma (HCC). We aimed to evaluate whether this model could be applicable in an East Asian cohort from a country in which the majority of patients undergo living donor liver transplantation (LT). This retrospective study enrolled consecutive patients who underwent LR for transplantable HCC between 2011 and 2018 in our institution. The occurrence of NTR after LR was analyzed in a competing risks analysis, with death and transplantable recurrence as competing events. A total of 309 patients were included. The five-year overall survival and recurrence-free survival were 79.0% and 51.4%, respectively (median follow-up: 32.0 months). Recurrence was noted in 94 (30.4%) patients. NTR was noted in 35 (11.3%) patients. Univariate analysis showed that cirrhosis (sub-distribution hazard ratio (SHR) = 2.301, 95% CI = 1.046–5.065; p = 0.038) and image-diagnosed tumor number > 1 (SHR = 2.32; 95% CI = 1.11–4.86; p = 0.026) were associated with NTR, whereas AFP > 100 ng/ml (SHR = 1.56; 95% CI = 0.59–4.10; p = 0.37) was not associated with NTR. In the presence of 0, 1, and 2 factors (i.e. cirrhosis or image-diagnosed tumor number > 1), the NTR rates were 7.2%, 10.8%, and 29.0%, respectively. The results showed that the French model was applicable to our cohort. In the presence of two factors (i.e. cirrhosis and image-diagnosed tumor number > 1), risks and benefits of upfront LT could be discussed with the patient and the living donor.

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Acknowledgements

The authors thank Cancer Center, Kaohsiung Chang Gung Memorial Hospital for the provision of HCC registry data. The authors thank Chih-Yun Lin and Nien-Tzu Hsu and the Biostatistics Center, Kaohsiung Chang Gung Memorial Hospital for statistics work.

Funding

This study was supported by Grant CMRPG8J1281 from the Chang Gung Memorial Hospital-Kaohsiung Medical Center, Taiwan.

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  1. Wei-Feng Li and Yi-Hao Yen contributed equally.

Authors and Affiliations

  1. Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta Pei Road, Kaohsiung, Taiwan

    Wei-Feng Li, Yueh-Wei Liu, Chih-Chi Wang, Chee-Chien Yong & Chih-Che Lin

  2. Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta Pei Road, Kaohsiung, Taiwan

    Yi-Hao Yen

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  1. Wei-Feng Li
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Correspondence to Yi-Hao Yen or Chih-Chi Wang.

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The Institutional Review Board of Kaohsiung Chang Gung Memorial Hospital approved this study (Reference number: 202000398B0) and waived the need for informed consent.

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Li, WF., Yen, YH., Liu, YW. et al. Preoperative predictors of non-transplantable recurrence after resection for early-stage hepatocellular carcinoma: application in an East Asian cohort. Updates Surg 74, 891–897 (2022). https://doi.org/10.1007/s13304-021-01220-2

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