Introduction: In spite of the high frequency of recurrence of hepatocellular carcinoma (HCC) after resection, little evidence exists to directly help to plan a reasonable schedule for the frequency and intensity of postoperative surveillance for recurrence. Methods: 1,918 consecutive patients with Child-Turcott-Pugh class A who had T1- or T2-staged HCCs detected by active surveillance and underwent curative resection for their tumors at 3 teaching hospitals in Korea, followed by recurrence screening at 6-monthly or shorter intervals. To set an evidence-based timetable for postoperative surveillance, we investigated the annual hazard rate of recurrence through postoperative year 10 in patients undergoing hepatectomy for HCC, and the clinical and morphological phenotypes associated with early versus late recurrence. Results: The estimated hazard rate for recurrence peaked during year 0–1 (21.7%), with a subsequent gradual decrease through 5 years, followed by stabilization at #x3c;7.0% until year 10, except in the case of cirrhotics, who had a rate of 10.5% during year 4–5. Multivariate time-to-recurrence analysis by recurrence period revealed that serum alpha-fetoprotein ≥200 ng/mL, larger size of tumor, tumor multiplicity, microvascular invasion, capsular invasion, and higher METAVIR fibrosis stage were significantly related to disease recurrence within 5 years after resection, while cirrhosis (METAVIR F4) alone was related to disease recurrence beyond 5 years (Ps #x3c; 0.05). Post-relapse overall survival was better in the latter group (p = 0.033). Conclusions: Our chronological and morphological insights into recurrence after resection of primary HCCs may help implement an optimal intensity of surveillance for recurrence.
Liver Cancer

中文翻译：

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切除后特定时期的复发风险作为肝细胞癌患者监测策略的框架：一项多中心结果研究

简介：尽管肝细胞癌 (HCC) 切除后复发的频率很高，但几乎没有证据可以直接帮助规划合理的时间表，以制定术后复发监测的频率和强度。方法：连续 1,918 名 Child-Turcott-Pugh A 级患者通过主动监测发现 T1 或 T2 期 HCC，并在韩国的 3 家教学医院接受了肿瘤的根治性切除术，然后以 6 个月或更短的时间间隔进行复发筛查。为了制定术后监测的循证时间表，我们调查了接受肝切除术的 HCC 患者术后 10 年的年度复发风险率，以及与早期和晚期复发相关的临床和形态表型。结果：估计的复发风险率在 0-1 年达到峰值 (21.7%)，随后在 5 年内逐渐下降，随后稳定在 #x3c;7.0% 直到第 10 年，肝硬化患者除外，其发生率在第 4-5 年期间为 10.5%。按复发期进行的多因素复发时间分析显示，血清甲胎蛋白≥200 ng/mL、肿瘤体积较大、肿瘤多发、微血管侵犯、包膜侵犯和较高的 METAVIR 纤维化分期与 5 年内疾病复发显着相关切除后，单独的肝硬化（METAVIR F4）与超过 5 年的疾病复发有关（P s #x3c；0.05）。后一组的复发后总生存期更好（p = 0.033）。结论：我们对原发性 HCC 切除后复发的时间和形态学见解可能有助于实施最佳的复发监测强度。
肝癌