Impact of time‐to‐surgery on outcomes of patients undergoing curative‐intent liver resection for BCLC‐0, A and B hepatocellular carcinoma. Issue 2 (11th November 2020)

• Record Type: Journal Article
• Authors: Tsilimigras, Diamantis I.; Hyer, J. Madison; Diaz, Adrian; Moris, Demetrios; Bagante, Fabio; Ratti, Francesca; Marques, Hugo P.; Soubrane, Olivier; Lam, Vincent; Poultsides, George A.; Popescu, Irinel; Alexandrescu, Sorin; Martel, Guillaume; Workneh, Aklile; Guglielmi, Alfredo; Hugh, Tom; Aldrighetti, Luca; Endo, Itaru; Pawlik, Timothy M.
• Is Part Of: Journal of surgical oncology. Volume 123:Issue 2(2021)
• Page Start: 381
• Page End: 388
• Publication Date: 2020-11-11
• Subjects: BCLC -- hepatocellular carcinoma -- liver -- resection -- time‐to‐surgery; Cancer -- Surgery -- Periodicals; Neoplasms -- Periodicals; 616
• DOI: 10.1002/jso.26297
• Languages: English
• ISSNs: 0022-4790

Abstract

Abstract: Background: The impact of a prolonged time‐to‐surgery (TTS) among patients with resectable hepatocellular carcinoma (HCC) is not well defined. Methods: Patients who underwent curative‐intent hepatectomy for BCLC‐0, A and B HCC between 2000 and 2017 were identified using a multi‐institutional database. The impact of prolonged TTS on overall survival (OS) and disease‐free survival (DFS) was examined. Results: Among 775 patients who underwent resection for HCC, 537 (69.3%) had early surgery (TTS < 90 days) and 238 (30.7%) patients had a delayed surgery (TTS ≥ 90 days). Patient‐ and tumor‐related characteristics were similar between the two groups except for a higher proportion of patients undergoing major liver resection in the early surgery group (31.3% vs. 23.8%, p = .04). The percentage of patients with delayed surgery varied from 8.8% to 59.1% among different centers ( p < .001). Patients with TTS < 90 days had similar 5‐year OS (63.7% vs. 64.9; p = .79) and 5‐year DFS (33.5% vs. 42.4; p = .20) with that of patients with TTS ≥ 90 days. On multivariable analysis, delayed surgery was not associated with neither worse OS (BCLC‐0/A: adjusted hazards ratio [aHR] = 0.90; 95% confidence interval [CI]: 0.65–1.25 and BCLC‐B: aHR = 0.72; 95%CI: 0.30–1.74) nor DFS (BCLC‐0/A: aHR = 0.78; 95%CI: 0.60–1.01 and BCLC‐B: aHR = 0.67; 95% CI: 0.36–1.25). Conclusion: Approximately one in three patients diagnosed with resectable HCC had a prolonged TTS. Delayed surgery was not associated with worse outcomes among patients with resectable HCC.