162P - Recurrence pattern of hepatocellular carcinoma patients receiving curative surgery of RFA: An update

Background

Hepatocellular carcinoma (HCC) after curative treatment has an estimated 5-year recurrence rate up to 70% [1]. Intrahepatic recurrence follows a bimodal pattern, with early recurrence occurring within 2 years and late recurrence occurring at 5 years [2]. It is unknown whether the bimodal recurrence pattern remains in the era of antivirals, which could reduce late recurrence. In this study, we provide an update of the characteristics of recurrence pattern.

Methods

Eligible patients who had received surgery or RFA for HCC from Oct 2000 to Jul 2017 were recruited at the Prince of Wales Hospital, Hong Kong. Patients’ and tumors’ characteristics were collected. Pattern of recurrence was classified by the occurrence of intrahepatic (local) recurrence or presence of distant metastasis (DM). Time-to-recurrence (TTR) and overall survival (OS) measure the time between the diagnosis of HCC to the time of first recurrence and death due to any cause respectively. Both TTR and OS were assessed using Kaplan-Meier Method. Prognostic factors for LR and DM were assessed using univariate and multivariate Cox Proportional Hazards Model.

Results

1082 patients were recruited. There were 908 (84%) males. 834 (77%) patients had HBV and 76 (7%) patients had HCV. 831 (77%) patients had BCLC stage 0/A and 243 (23%) patients had BCLC stage B/C HCC. 997 (92%) and 676 (63%) patients had Child-Pugh A and ALBI grade 1 liver function respectively. Median tumor size was 3.5cm. 834 (77%) patients had solitary HCC, and 99 (9%), 21 (2%) and 126 (12%) patients had 2, 3 and ≥3 HCCs respectively. 863 (80%) patients received surgery and 219 (20%) patients received RFA. The TTR for both LR and DM peaked at 9 to 12 months then dropped progressively. The bimodal recurrence pattern was not apparent. In patients who developed recurrence, median OS was longest in those with LR only at 64.8 months, versus shortest in those who developed DM first then LR at 13.3 months.

Conclusions

In the era of antivirals, the bimodal recurrence pattern is not observed with a marked reduction of late recurrence. The pattern of recurrence influences the prognosis: patients with LR have significantly better OS than DM. These findings are important for future research on adjuvant and salvage treatment for recurrent HCC.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

L.L. Chan: Other, Personal, Other, Travel Grant: Roche. K. Mok: Other, Personal, Other, Travel Grant: AstraZeneca, Eisai. S.L. Chan: Financial Interests, Personal, Advisory Board: Eisai, AstraZeneca, MSD, BMS, Roche; Financial Interests, Personal, Invited Speaker: AstraZeneca, MSD, Eisai, Roche, Ipsen, BMS; Financial Interests, Personal, Research Grant: Eisai, MSD. All other authors have declared no conflicts of interest.