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

Research output: Contribution to journalArticlepeer-review

6 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 languageEnglish
Pages (from-to)571-582
Number of pages12
JournalGut and Liver
Volume12
Issue number5
DOIs
StatePublished - 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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