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Overall survival among patients who undergo resection does not differ significantly between T1a and T1b hepatocellular carcinoma based on the 8th American Joint Commission on Cancer

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Abstract

Purpose

The 8th edition of the American Joint Committee on Cancer (AJCC) staging system for hepatocellular carcinoma (HCC) has been used since 2018. However, whether any significant difference in overall survival (OS) exists between patients with T1a and T1b HCC who undergo resection has been controversial. We aim to clarify this issue.

Methods

We consecutively enrolled newly diagnosed HCC patients who underwent liver resection (LR) from 2010 to 2020 at our institution. OS was estimated using the Kaplan–Meier method and compared using log-rank tests. Prognostic factors for OS were identified by multivariate analysis.

Results

This study enrolled 1250 newly diagnosed HCC patients who underwent LR. No significant differences in OS were identified between patients with T1a and T1b tumors among all patients (p = 0.694), cirrhotic patients (p = 0.753), non-cirrhotic patients (p = 0.146), patients with alpha-fetoprotein (AFP) > 20 ng/ml (p = 0.562), patients with AFP ≤ 20 ng/ml (p = 0.967), patients with Edmondson grade 1 or 2 (p = 0.615), patients with Edmondson grade 3 or 4 (p = 0.825), patients positive for hepatitis B surface antigen (HBsAg; p = 0.308), in patients positive for anti-hepatitis C virus (HCV) antibody (p = 0.781), or patients negative for both HBsAg and anti-HCV antibody (p = 0.125). Using T1a as the reference, multivariate analysis showed that T1b is not a significant predictive factor for OS (hazard ratio (HR): 1.338; 95% confidence interval (CI):0.737–2.431; p = 0.339).

Conclusion

No significant difference in OS was observed between patients who underwent LR to treat T1a and T1b HCC tumors.

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Data availability

All data are available.

References

  1. Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Allen C, Barber RM et al (2017) Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the global burden of disease study. JAMA Oncol 3:524–548. https://doi.org/10.1001/jamaoncol.2016.5688

    Article  PubMed Central  Google Scholar 

  2. Yang JD, Hainaut P, Gores GJ et al (2019) A global view of hepatocellular carcinoma: Trends, risk, prevention and management. Nat Rev Gastroenterol Hepatol 16:589–604. https://doi.org/10.1038/s41575-019-0186-y

    Article  PubMed  PubMed Central  Google Scholar 

  3. EASL Clinical Practice Guidelines (2018) Management of hepatocellular carcinoma. J Hepatol 69:182–236. https://doi.org/10.1016/j.jhep.2018.03.019

    Article  Google Scholar 

  4. Marrero JA, Kulik LM, Sirlin CB et al (2018) Diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by the American Association for the Study of Liver Diseases. Hepatology 68:723–750. https://doi.org/10.1002/hep.29913

    Article  PubMed  Google Scholar 

  5. Abou-Alfa GK, Pawlik TM, Shindoh J, Vauthey JN (2017) Liver. In: AJCC cancer staging manual, 8th ed, Amin MB (Ed), AJCC, Chicago, p 287

  6. Shindoh J, Andreou A, Aloia TA et al (2013) Microvascular invasion does not predict long-term survival in hepatocellular carcinoma up to 2 cm: reappraisal of the staging system for solitary tumors. Ann Surg Oncol 20:1223–1229. https://doi.org/10.1245/s10434-012-2739-y

    Article  PubMed  Google Scholar 

  7. Kamarajah SK, Frankel TL, Sonnenday C et al (2018) Critical evaluation of the American Joint Commission on Cancer (AJCC) 8th edition staging system for patients with hepatocellular carcinoma (HCC): a Surveillance, Epidemiology, End Results (SEER) analysis. J Surg Oncol 117:644–650. https://doi.org/10.1002/jso.24908

    Article  CAS  PubMed  Google Scholar 

  8. Park S, Choi S, Cho YA et al (2020) Evaluation of the American Joint Committee on Cancer (AJCC) 8th edition staging system for hepatocellular carcinoma in 1,008 patients with curative resection. Cancer Res Treat 52:1145–1152. https://doi.org/10.4143/crt.2020.208

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kim IG, Hu XG, Wang HJ et al (2019) The 7th/8th American Joint Committee on Cancer and the modified Union for International Cancer Control Staging System for Hepatocellular Carcinoma. Yonsei Med J 60:140–147. https://doi.org/10.3349/ymj.2019.60.2.140

    Article  PubMed  PubMed Central  Google Scholar 

  10. Zhang G, Li R, Zhao X et al (2018) Validation of the American Joint Committee on Cancer eighth edition staging system in patients undergoing hepatectomy for hepatocellular carcinoma: a US population-based study. J Surg Res 222:55–68. https://doi.org/10.1016/j.jss.2017.09.044

    Article  PubMed  Google Scholar 

  11. Liu YW, Yong CC, Lin CC et al (2021) Six months as a cutoff time point to define early recurrence after liver resection of hepatocellular carcinoma based on post-recurrence survival. Updates Surg 73:399–409. https://doi.org/10.1007/s13304-020-00931-2

    Article  PubMed  Google Scholar 

  12. Kuo FY, Liu YW, Lin CC et al (2021) Microscopic portal vein invasion is a powerful predictor of prognosis in patients with hepatocellular carcinoma who have undergone liver resection. J Surg Oncol 123:222–235. https://doi.org/10.1002/jso.26260

    Article  CAS  PubMed  Google Scholar 

  13. Edmonson H, Steiner P (1954) Primary carcinoma of the liver: a study of 100 cases among 48,900 necropsies. Cancer 7:462–503. https://doi.org/10.1002/1097-0142(195405)7:3%3c462::aid-cncr2820070308%3e3.0.co;2-e

    Article  Google Scholar 

  14. Everhart JE, Wright EC, Goodman ZD et al (2010) Prognostic value of Ishak fibrosis stage: findings from the hepatitis C antiviral long-term treatment against cirrhosis trial. Hepatology 51:585–594. https://doi.org/10.1002/hep.23315

    Article  PubMed  Google Scholar 

  15. European Association for the Study of the Liver, European Organisation For Research and Treatment of Cancer (2012) EASL-EORTC clinical practice guidelines management of hepatocellular carcinoma. J Hepatol 56:908–943. https://doi.org/10.1016/j.jhep.2011.12.001

    Article  Google Scholar 

  16. Omata M, Lesmana LA, Tateishi R et al (2010) Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol Int 4:439–474. https://doi.org/10.1007/s12072-010-9165-7

    Article  PubMed  PubMed Central  Google Scholar 

  17. Bruix J, Sherman M (2011) American Association for the Study of Liver Diseases Management of hepatocellular carcinoma: an update. Hepatology 53:1020–1022. https://doi.org/10.1002/hep.24199

    Article  PubMed  Google Scholar 

  18. Zhou Y, Zhang Z, Zhao Y et al (2014) Antiviral therapy decreases recurrence of hepatitis B virus-related hepatocellular carcinoma after curative resection: a meta-analysis. World J Surg 38:2395–402. https://doi.org/10.1007/s00268-014-2586-z

    Article  PubMed  Google Scholar 

  19. AASLD/IDSA HCV Guidance Panel (2015) Hepatitis C guidance: AASLD-IDSA recommendations for testing, managing, and treating adults infected with hepatitis C virus. Hepatology 62:932–954. https://doi.org/10.1002/hep.27950

    Article  Google Scholar 

  20. Mazzaferro V, Regalia E, Doci R et al (1996) Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 334:693–699. https://doi.org/10.1056/NEJM199603143341104

    Article  CAS  PubMed  Google Scholar 

  21. Garcia-Tsao G, Abraldes JG, Berzigotti A et al (2017) Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology 65:310–335. https://doi.org/10.1002/hep.28906

    Article  PubMed  Google Scholar 

  22. Goh BK, Teo JY, Chan CY et al (2016) Importance of tumor size as a prognostic factor after partial liver resection for solitary hepatocellular carcinoma: implications on the current AJCC staging system. J Surg Oncol 113:89–93. https://doi.org/10.1002/jso.24099

    Article  PubMed  Google Scholar 

  23. Zhang H, Yuan SX, Dai SY et al (2014) Tumor size does not independently affect long-term survival after curative resection of solitary hepatocellular carcinoma without macroscopic vascular invasion. World J Surg 38:947–957. https://doi.org/10.1007/s00268-013-2365-2

    Article  PubMed  Google Scholar 

  24. Vauthey N, Lauwers GY, Esnaola NF et al (2002) Simplified staging for hepatocellular carcinoma. J Clin Oncol 20:1527–1536. https://doi.org/10.1200/JCO.2002.20.6.1527

    Article  PubMed  Google Scholar 

  25. American Joint Committe on Cancer (2010) American joint committe on cancer staging manual, 7th ed. In: Edge SB, Byrd DR, Compton CC (eds). Springer, New York, NY, p175

  26. Benson AB, D’Angelica MI, Abbott DE et al (2021) Hepatobiliary cancers, version 2.2021, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 19:541–565. https://doi.org/10.6004/jnccn.2021.0022

    Article  PubMed  Google Scholar 

  27. Truty MJ, Vauthey JN (2010) Surgical resection of high-risk hepatocellular carcinoma: patient selection, preoperative considerations, and operative technique. Ann Surg Oncol 17:1219–1225. https://doi.org/10.1245/s10434-010-0976-5

    Article  PubMed  PubMed Central  Google Scholar 

  28. Abdalla EK, Denys A, Hasegawa K et al (2008) Treatment of large and advanced hepatocellular carcinoma. Ann Surg Oncol 15:979–985. https://doi.org/10.1245/s10434-007-9727-7

    Article  PubMed  Google Scholar 

  29. Vibert E, Schwartz M, Olthoff KM (2020) Advances in resection and transplantation for hepatocellular carcinoma. J Hepatol 72:262–276. https://doi.org/10.1016/j.jhep.2019.11.017

    Article  CAS  PubMed  Google Scholar 

  30. Crocetti L, Bargellini I, Cioni R (2017) Loco-regional treatment of HCC: current status. Clin Radiol 72:626–635. https://doi.org/10.1016/j.crad.2017.01.013

    Article  CAS  PubMed  Google Scholar 

  31. Llovet JM, Ricci S, Mazzaferro V et al (2008) Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 359:378–390. https://doi.org/10.1056/NEJMoa0708857

    Article  CAS  PubMed  Google Scholar 

  32. Singal AG, Rich NE, Mehta N et al (2019) Direct-acting antiviral therapy for hepatitis c virus infection is associated with increased survival in patients with a history of hepatocellular carcinoma. Gastroenterology 157:1253-1263.e2. https://doi.org/10.1053/j.gastro.2019.07.040

    Article  CAS  PubMed  Google Scholar 

  33. Llovet JM, Bru C, Bruix J (1999) Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 19:329–338. https://doi.org/10.1055/s-2007-1007122

    Article  CAS  PubMed  Google Scholar 

Download references

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 CMRPG8L0181 from the Chang Gung Memorial Hospital-Kaohsiung Medical Center, Taiwan.

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Author notes

  1. Chih-Chi Wang and Yi-Hao Yen contributed equally.

Authors and Affiliations

  1. Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

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

  2. Department of Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

    Fang-Ying Kuo & Hock-Liew Eng

  3. Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

    Yi-Hao Yen

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Contributions

1. Conception or design of the work: YHY, CCW

2. The acquisition, analysis, or interpretation of data: WFL, YWL, CCW, CCY, CCL, FYK, HLE

3. Drafted the work: YWL

4. Revised it critically for important intellectual content: CCW

5. Approved the version to be published: all authors

6. Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: all authors

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Correspondence to Chih-Chi Wang or Yi-Hao Yen.

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Liu, YW., Li, WF., Kuo, FY. et al. Overall survival among patients who undergo resection does not differ significantly between T1a and T1b hepatocellular carcinoma based on the 8th American Joint Commission on Cancer. Langenbecks Arch Surg 408, 166 (2023). https://doi.org/10.1007/s00423-023-02841-4

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