BACKGROUND & AIMS The Barcelona Clinic Liver Cancer (BCLC) guidelines recommend resection for very early and early single hepatocellular carcinoma (HCC) patients. It is not known whether a delay in resection from the time of diagnosis (the time to surgery [TTS], i.e. the elapsed time from diagnosis to surgery) affects outcomes. We aim to evaluate the impact of TTS on recurrence and survival outcomes in patients with HCC. METHODS All patients resected for BCLC stage 0-A single HCC from 2006 to 2016 were studied to evaluate the impact of TTS on recurrence rate, recurrence-free survival (RFS), transplantability following recurrence, and intention-to-treat overall survival (ITT-OS). Propensity score matching (PSM) was further performed to ensure comparability. RESULTS The study population included 100 patients. Surgery was performed between 0.6 and 77 months after diagnosis (median TTS: three months; interquartile range: 1.8-4.6 months). There was no post-operative mortality. Compared to those with TTS <3 months, patients with TTS ≥3 months (70% of these patients had TTS 3-6 months) had a higher post-operative morbidity (36% vs. 16%, p = 0.02), a similar tumor recurrence rate (32% vs. 32%, p = 1.00), RFS (37% vs. 48%, p = 0.42), transplantability following tumor recurrence (63% vs. 50%, p = 0.48), and five-year ITT-OS (82% vs. 80%, p = 0.20). Similar results were observed after PSM. CONCLUSION Patients with BCLC stage 0-A single HCC can undergo surgery with TTS ≥3 months without impaired oncologic outcomes. An increase in the TTS within a safe range could allow time for proper evaluation before surgery, and ethical testing of new neoadjuvant treatments, aiming to reduce the high rate of tumor recurrence despite curative resection. LAY SUMMARY A delay of ≥3 months in time to resection after diagnosis in HCC patients meeting the European Association for the Study of Liver Disease/American Association for the Study of Liver Disease criteria for resection does not affect oncological and long-term outcomes compared to those with a delay to surgery of <3 months.

中文翻译：

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手术时间对 BCLC 0-A 期肝细胞癌肝切除患者结局的影响

背景和目的 巴塞罗那临床肝癌 (BCLC) 指南建议对极早期和早期单发性肝细胞癌 (HCC) 患者进行切除术。尚不清楚从诊断时（到手术时间 [TTS]，即从诊断到手术所经过的时间）延迟切除是否会影响结果。我们旨在评估 TTS 对 HCC 患者复发和生存结果的影响。方法 对 2006 年至 2016 年间因 BCLC 0-A 期单发 HCC 切除的所有患者进行研究，以评估 TTS 对复发率、无复发生存期 (RFS)、复发后可移植性和意向治疗总生存期 (ITT) 的影响。 -操作系统）。进一步进行倾向得分匹配（PSM）以确保可比性。结果 研究人群包括 100 名患者。0 点之间进行了手术。诊断后 6 个月和 77 个月（中位 TTS：3 个月；四分位距：1.8-4.6 个月）。无术后死亡。与 TTS <3 个月的患者相比，TTS ≥ 3 个月的患者（其中 70% 的患者 TTS 为 3-6 个月）的术后发病率更高（36% 对 16%，p = 0.02），相似肿瘤复发率 (32% vs. 32%, p = 1.00), RFS (37% vs. 48%, p = 0.42), 肿瘤复发后可移植性 (63% vs. 50%, p = 0.48), 和五年 ITT-OS（82% 对 80%，p = 0.20）。在 PSM 之后观察到类似的结果。结论 BCLC 0-A 期单发 HCC 患者可以接受 TTS ≥ 3 个月的手术而不会损害肿瘤学结果。TTS 在安全范围内的增加可以让我们有时间在手术前进行适当的评估，并对新的新辅助治疗进行伦理测试，旨在减少根治性切除后的高肿瘤复发率。LAY Summary 与欧洲肝病研究协会/美国肝病研究协会的切除标准相比，HCC 患者在诊断后延迟 ≥3 个月进行切除并不影响肿瘤学和长期结局。手术延迟<3个月的患者。