肝癌切除术后的长间隔与短间隔随访:一项回顾性队列研究

背景与目的由于缺乏证据证明肝细胞癌(hepatocellular carcinoma,HCC)切除术后的最佳随访间隔,术后患者接受随访的平均时间间隔不同。我们的目的是比较长间隔随访和短间隔随访与生存和复发的相关性在不同风险分层肝癌患者中的差异。方法我们在2007年至2014年期间进行了一项回顾性队列研究。共有1227例巴塞罗那临床肝癌分期A期或B期的患者接受了根治性切除术。根据最小绝对收缩和选择操作算法为基础的预后因素分析,我们将患者分层为有低风险(n=865)或高风险(n=362)早期复发(切除术后2年内)的2组。根据切除术后2年内的随访情况,患者进一步分为长间隔(每4–6个月)随访和短期间隔(每2–4个月)随访的亚组(低风险,长期vs.短期:n=390 vs. n=475;高风险,长期vs.短期:n=149 vs. n=213)。结果不管在低风险[风险比(hazard ratio,HR)=1.152;95%置信区间(confidenceinterval,CI):0.720–1.843]还是高风险(HR=1.213;95%CI:0.702–2.094)患者中,短间隔随访没有延长患者的总生存期。401例患者出现早期复发。在高风险患者中,与长间隔随访组相比,短间隔组肝内复发肿瘤较小(2.6 cm vs. 3.5 cm,P=0.045)。但是,对于巴塞罗临床肝癌分期0/A期,长间隔与短间隔随访不管在低风险还是高风险患者中复发率(63.1%vs. 68.2%,P=0.580;31.3%vs. 41.5%,P=0.280)差异均无统计学意义。类似的,根治性切除术后,长间隔或短间隔随访分别在低风险和高风险患者中的复发率(34.5%vs. 39.7%,P=0.430;14.6%vs. 20.3%,P=0.388)差异也均无统计学意义。结论对于巴塞罗那临床肝癌分期A期或B期的患者,在接受了根治性切除术后的前2年内,将随访时间从4–6月缩短为2–4个月并不能增加根治性切除术的成功率或延长患者生存时间。

Long- versus short-interval follow-up after resection of hepatocellular carcinoma: a retrospective cohort study

Background:Average postoperative follow-up intervals vary in patients undergoing hepatocellular carcinoma(HCC)resection because of limited evidence regarding the optimal interval.We aimed to compare the associations of long-versus short-interval follow-up with survival and recurrence in risk-stratified HCC patients.Methods:We performed a retrospective cohort study between 2007 and 2014.In total,1227 patients treated by curative resection of Barcelona Clinic Liver Cancer stage A or B HCC were stratified as having a low(n=865)or high(n=362)risk of early recurrence(within the first 2 years after resection)based on prognostic factors identified by the least absolute shrinkage and selection operation algorithm.Patients were further classified into long-interval(every 4-6 months)and short-interval(every 2-4 months)follow-up subgroups based on follow-up within 2 years after resection(low risk,long vs.short:n=390 vs.n=475;high-risk,long vs.short:n=149 vs.n=213).Results:The short-interval follow-up did not prolong overall survival in either the low-risk(hazard ratio[HR]=1.152;95%confidence interval[CI]0.720-1.843)or high-risk(HR=1.213;95%CI 0.702-2.094)patients.Early recurrence occurred in 401 patients.For high-risk patients,the short-interval follow-up subgroup exhibited smaller intrahepatic recurrence than did the long-interval group(2.6 vs.3.5 cm,respectively,P=0.045).However,no significant difference in the rate of Barcelona Clinic Liver Cancer stage 0/A recurrence was found between the long-and short-interval follow-up groups in either low-or high-risk patients(63.1%vs.68.2%,respectively,P=0.580;31.3%vs.41.5%,respec-tively,P=0.280).The rate of curative intent treatment for recurrence(34.5%vs.39.7%,respectively,P=0.430;14.6%vs.20.3%,respectively,P=0.388)was also similar between the follow-up groups for low-and high-risk patients.Conclusions:Shortening the postoperative follow-up interval from every 4-6 months to every 2-4 months within the first 2 years after resection did not increase the rate of curative intent treatment or prolong the overall survival of patients with Barcelona Clinic Liver Cancer stage A or B HCC.