Secondarily estimated cure fraction and five-year recurrence-free conditional survival probabilities among patients undergoing surgical resection for hepatocellular carcinoma presenting with minor gross vascular invasion

Abstract

Background Surgical resection (SR) has been selectively applied in hepatocellular carcinoma (HCC) presenting with minor gross vascular invasion (mGVI) which is defined when tumor invasion is confined to second-order portal branches or segmental branches of hepatic vein. However, little data of long-term outcomes are available for supporting the role of SR as a potentially curable therapeutic option for HCC presenting with mGVI. This study is aimed to estimate a statistical cure fraction and the improvement of recurrence-free conditional survival (RFCS) over time among patients undergoing SR for HCC presenting with mGVI. Methods The literature search was conducted focusing on previous studies that investigated the long-term survival rates of patients after SR for HCC presenting with mGVI. The reference cohort was extracted from a study including patients undergoing SR for HCC without vascular invasion. A non-mixture cure model was adopted to estimate the statistical cure fraction. The 5-year RFCS probabilities were also calculated. Results Three retrospective studies were secondarily analyzed. The probability of being statistically cured after SR for HCC presenting with mGVI was 7.3% (95% confidence interval, 4.4%–11.2%) in the mGVI group, lower than that of the reference cohort (hazard ratio, 1.81; 95% confidence interval, 1.59–2.05). The estimated 5-year RFCS probabilities improved with each additional year of survival. Moreover, 1 year after SR, the 5-year RFCS probabilities of patients with HCC presenting with mGVI was essentially the same as that of the reference cohort. Conclusions This study shows that a cure can be expected in around seven percent of patients undergoing SR for HCC presenting with mGVI. Furthermore, recurrence-free survival expectancy improves dramatically over time among those patients who do not have recurrence. Overall, these findings suggest that SR should be considered as a potentially curable treatment for patients with HCC presenting with mGVI.

Prognostic difference between surgery and external radiation in patients with stage I liver cancer based on competitive risk model and conditional survival rate

“…It is calculated based on the patient’s survival time and is more relevant to the actual clinical practice because it can measure the patient’s survival risk over a certain period. Conditional probability analysis is increasingly used to analyze the long-term effects of tumor characteristics [ 25 ]and is particularly suitable for comparing the difference between immediate and late-stage survival benefits after treatment [ 26 ].…”

“…Close follow-up and re-examination are needed for timely treatment to reduce mortality. Previous studies [ 26 ] had shown that approximately 7% of patients undergoing surgical treatment for HCC with mild gross vascular infiltration were expected to be cured, and conditional survival probability analysis could also be used to guide the follow-up of such patients after surgery [ 15 ]. These findings were different from our study because their research object was liver cancer patients with mild gross vascular infiltration who showed a worse prognosis than that of stage I liver cancer patients.…”

“…long-term effects of tumor characteristics [25]and is particularly suitable for comparing the difference between immediate and late-stage survival benefits after treatment [26].…”

Individual and joint influence of cytokeratin 19 and microvascular invasion on the prognosis of patients with hepatocellular carcinoma after hepatectomy

“…Gross vascular invasion is usually a consequence of MVI progression. The poor prognosis of HCC with gross vascular invasion has been clarified, but it has a relatively large impact on the prognosis, which is not conducive to the accurate classification of the prognosis [ 35 ]. Therefore, we advocate combining CK19 and MVI to analyze the prognosis.…”