Factors predicting long-term outcome of early stage hepatocellular carcinoma after primary curative treatment - the role of surgical or nonsurgical methods

Background: The effect of putative factors on the clinical course of early hepatocellular carcinoma (HCC) after primary surgical or nonsurgical curative treatment, which remains elusive, was quantified. Methods: Patients with newly diagnosed early HCC who received surgical resection (SR) or percutaneous radiofrequency ablation (RFA) with or without transcatheter arterial chemoembolization (TACE) from January 2003 to December 2016 were enrolled. The cumulative overall survival (OS) and disease-free survival (DFS) were compared. A polytomous logistic regression was used to estimate factors regarding early and late recurrence. Independent predictors of OS were identified using Cox proportional hazard regression. Results: One hundred twenty-five patients underwent SR, and 176 patients underwent RFA, of whom 72 were treated with TACE followed by RFA. Either match analysis based on propensity score or multiple adjustment regression showed no significant difference in DFS and OS between the two groups. Multivariate analysis showed high AFP (>= 20 ng/mL), and multinodularity significantly increased risk of early recurrence (1year). Multivariate Cox regression with recurrent events as time-varying covariates identified older age (HR=1.55, 95% CI:1.01-2.36), clinically significant portal hypertension (CSPH) (HR=1.97, 95% CI:1.26-3.08), early recurrence (HR=6.62, 95% CI:3.79-11.6) and late recurrence (HR=3.75, 95% CI:1.99-7.08) as independent risk factors of mortality. A simple risk score showed fair calibration and discrimination in early HCC patients after primary curative treatment. In the Barcelona Clinic Liver Cancer (BCLC) stage A subgroup, SR significantly improved DFS comparing to those received RFA with or without TACE. Conclusion: Host and tumor factors rather than the initial treatment modalities determine the outcomes of early HCC after primary curative treatment. Statistical models based on recurrence types can predict early HCC prognosis but further external validation is necessary.