Assessment of the surveillance interval at 1 year after curative treatment in hepatocellular carcinoma: Risk stratification

Minjong Lee; 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

doi:10.5009/gnl17365

Assessment of the surveillance interval at 1 year after curative treatment in hepatocellular carcinoma: Risk stratification

Minjong Lee, 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

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

8 Scopus citations

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.

Original language	English
Pages (from-to)	571-582
Number of pages	12
Journal	Gut and Liver
Volume	12
Issue number	5
DOIs	https://doi.org/10.5009/gnl17365
State	Published - Sep 2018

Bibliographical note

Publisher Copyright:
© 2018 Editorial Office of Gut and Liver. All rights reserved.

Keywords

Carcinoma
Curative treatment
Hepatocellular
Risk stratification
Surveillance interval

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10.5009/gnl17365

Cite this

Lee, M., Chang, Y., Oh, S., Cho, Y. Y., Jung, D. E., Kim, H. H., Nam, J. Y., Cho, H., Cho, E. J., Lee, J. H., Yu, S. J., Yi, N. J., Lee, K. W., Lee, D. H., Lee, J. M., Yoon, J. H., Suh, K. S., & Kim, Y. J. (2018). Assessment of the surveillance interval at 1 year after curative treatment in hepatocellular carcinoma: Risk stratification. Gut and Liver, 12(5), 571-582. https://doi.org/10.5009/gnl17365

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title = "Assessment of the surveillance interval at 1 year after curative treatment in hepatocellular carcinoma: Risk stratification",

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.",

keywords = "Carcinoma, Curative treatment, Hepatocellular, Risk stratification, Surveillance interval",

author = "Minjong Lee and Young Chang and Sohee Oh and Cho, {Young Youn} and Jung, {Dhong Eun} and Kim, {Hong Hyun} and Nam, {Joon Yeul} and Hyeki Cho and Cho, {Eun Ju} and Lee, {Jeong Hoon} and Yu, {Su Jong} and Yi, {Nam Joon} and Lee, {Kwang Woong} and Lee, {Dong Ho} and Lee, {Jeong Min} and Yoon, {Jung Hwan} and Suh, {Kyung Suk} and Kim, {Yoon Jun}",

year = "2018",

month = sep,

doi = "10.5009/gnl17365",

language = "English",

volume = "12",

pages = "571--582",

journal = "Gut and Liver",

issn = "1976-2283",

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TY - JOUR

T1 - Assessment of the surveillance interval at 1 year after curative treatment in hepatocellular carcinoma

T2 - Risk stratification

AU - Lee, Minjong

AU - Chang, Young

AU - Oh, Sohee

AU - Cho, Young Youn

AU - Jung, Dhong Eun

AU - Kim, Hong Hyun

AU - Nam, Joon Yeul

AU - Cho, Hyeki

AU - Cho, Eun Ju

AU - Lee, Jeong Hoon

AU - Yu, Su Jong

AU - Yi, Nam Joon

AU - Lee, Kwang Woong

AU - Lee, Dong Ho

AU - Lee, Jeong Min

AU - Yoon, Jung Hwan

AU - Suh, Kyung Suk

AU - Kim, Yoon Jun

PY - 2018/9

Y1 - 2018/9

N2 - 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.

AB - 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.

KW - Carcinoma

KW - Curative treatment

KW - Hepatocellular

KW - Risk stratification

KW - Surveillance interval

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U2 - 10.5009/gnl17365

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SN - 1976-2283

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EP - 582

JO - Gut and Liver

JF - Gut and Liver

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ER -

Assessment of the surveillance interval at 1 year after curative treatment in hepatocellular carcinoma: Risk stratification

Abstract

Bibliographical note

Keywords

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