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Early Versus Late Recurrence of Hepatocellular Carcinoma After Surgical Resection Based on Post-recurrence Survival: an International Multi-institutional Analysis

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

To define early versus late recurrence based on post-recurrence survival (PRS) among patients undergoing curative resection for hepatocellular carcinoma (HCC).

Methods

Patients who underwent curative-intent resection for HCC between 2000 and 2017 were identified from an international multi-institutional database. The optimal cut-off time point to discriminate early versus late recurrence was determined relative to PRS.

Results

Among 1004 patients, 443 (44.1%) patients experienced recurrence with a median recurrence-free survival time of 12 months. A cut-off time point of 8 months was defined as the optimal threshold based on sensitivity analyses relative to PRS for early (n = 165, 37.2%) versus late relapse (n = 278, 62.8%) (p = 0.008). Early recurrence was associated with worse PRS (median PRS, 27.0 vs. 43.0 months, p = 0.019), as well as overall survival (OS) (median OS, 32.0 versus 74.0 months, p < 0.001) versus late recurrence. In addition, patients who recurred early were more likely to recur at extra- ± intrahepatic (35.5% vs. 19.8%, p = 0.003) sites and were less likely to have the recurrence treated with curative intent (33.8% vs. 45.7%, p = 0.08). Patients undergoing curative re-treatment of late recurrence had a comparable OS with patients who had no recurrence (median OS, 139.0 vs. 140.0 months); patients with early recurrence had inferior OS after curative re-treatment versus patients with no recurrence (median OS, 69.0 vs. 140.0 months, p = 0.036), yet still better than patients who received palliative treatment for early recurrence (median OS, 69.0 vs. 21.0 months, p < 0.001).

Conclusions

Eight months was identified as the cut-off value to differentiate early versus late recurrence. Curative-intent treatment for recurrent intrahepatic tumors was associated with reasonable long-term outcomes.

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Funding

Tao Wei and Xu-Feng Zhang were supported by the Clinical Research Award of the First Affiliated Hospital of Xi’an Jiaotong University of China (No. XJTU1AF-CRF-2017-004).

Author information

Author notes

  1. Tao Wei and Xu-Feng Zhang contributed equally to this work.

Authors and Affiliations

  1. Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

    Tao Wei, Xu-Feng Zhang & Yi Lv

  2. Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Tao Wei

  3. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner, Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA

    Fabio Bagante & Timothy M. Pawlik

  4. Department of Surgery, University of Verona, Verona, Italy

    Fabio Bagante & Alfredo Guglielmi

  5. Department of Surgery, Ospedale San Raffaele, Milan, Italy

    Francesca Ratti & Luca Aldrighetti

  6. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal

    Hugo P. Marques & Silvia Silva

  7. Department of Hepatobiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France

    Olivier Soubrane

  8. Department of Surgery, Westmead Hospital, Sydney, Australia

    Vincent Lam

  9. Department of Surgery, Stanford University, Stanford, CA, USA

    George A. Poultsides

  10. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania

    Irinel Popescu, Razvan Grigorie & Sorin Alexandrescu

  11. Department of Surgery, University of Ottawa, Ottawa, Canada

    Guillaume Martel & Aklile Workneh

  12. Department of Surgery, The University of Sydney, School of Medicine, Sydney, Australia

    Tom Hugh

Authors
  1. Tao Wei
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  2. Xu-Feng Zhang
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  3. Fabio Bagante
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  4. Francesca Ratti
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  6. Silvia Silva
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  7. Olivier Soubrane
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  8. Vincent Lam
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  9. George A. Poultsides
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  10. Irinel Popescu
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  11. Razvan Grigorie
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  12. Sorin Alexandrescu
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  13. Guillaume Martel
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  14. Aklile Workneh
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  15. Alfredo Guglielmi
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  16. Tom Hugh
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  17. Yi Lv
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  18. Luca Aldrighetti
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  19. Timothy M. Pawlik
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Corresponding author

Correspondence to Timothy M. Pawlik.

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Wei, T., Zhang, XF., Bagante, F. et al. Early Versus Late Recurrence of Hepatocellular Carcinoma After Surgical Resection Based on Post-recurrence Survival: an International Multi-institutional Analysis. J Gastrointest Surg 25, 125–133 (2021). https://doi.org/10.1007/s11605-020-04553-2

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  • DOI: https://doi.org/10.1007/s11605-020-04553-2

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