Conditional survival analysis of hepatocellular carcinoma

• Authors: Mihir Shah, Emory University; Benjamin Meyer, Emory University; Kevin Rhee, Rutgers Cancer Institute of New Jersey; Rachel E NeMoyer, Rutgers Robertwood Johnson Medical School; Yong Lin, Rutgers School of Public Health; Ching-Wei D Tzeng, University of Texas MD Anderson Cancer Center; Salma K Jabbour, Rutgers Cancer Institute of New Jersey; Timothy J Kennedy, Rutgers Cancer Institute of New Jersey; John L Nosher, Rutgers Robertwood Johnson Med Sch; David Kooby, Emory University; Shishir Maithel, Emory University; Darren R Carpizo, University of Rochester
• Journal Title: JOURNAL OF SURGICAL ONCOLOGY
• Volume: Volume 122, Number 4
• Publisher: WILEY | 2020-06-10, Pages 684-690
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1002/jso.26049
• Subjects: Health Sciences, Oncology; Health Sciences, Radiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; Surgery; cirrhosis; conditional survival; hepatocellular carcinoma; liver cancer; liver surgery; HEPATIC RESECTION; MANAGEMENT; TUMOR

Abstract

Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide with an approximate 5-year survival of greater than 50% in patients after surgical resection. Survival estimates have limited utility for patients who have survived several years after initial treatment. We analyzed how conditional survival (CS) after curative-intent surgery for HCC predicts survival estimates over time. Methods: NCDB (2004-2014) was queried for patients undergoing definitive surgical resection for HCC. Cumulative overall survival (OS) was calculated using the Kaplan-Meier method, and CS at x years after diagnosis was calculated as CS1 = OS (X+5)/OS(X). Results: The final analysis encompassed 11 357 patients. Age, negative margin status, grade severity and radiation before surgery were statistically significant predictors of cumulative overall conditional survival (P ≤.0001). Overall unconditional 5-year survival was 65.7%, but CS estimates were higher. A patient who has already survived 3 years has an additional 2-year, or 5-year CS, estimate of 86.96%. Conclusion: Survival estimates following hepatic resection in HCC patients change according to survival time accrued since surgery. CS estimates are improved relative to unconditional OS. The impact of different variables influencing OS is likewise nonlinear over the course of time after surgery.