Landmark analysis of the risk of recurrence after resection or ablation for HCC: A nationwide study

Abstract

Background: The risk of HCC recurrence at particular landmarks since the initial treatment is unknown. With this registry-based study, we aimed to provide a nuanced description of the prognosis following resection or ablation for HCC, including landmark analyses. Methods: Using the Danish nationwide health care registries, we identified all patients who received resection or ablation in 2000–2018 as the first HCC treatment. HCC recurrence was defined as a new HCC treatment > 90 days after the first treatment. We conducted competing risk landmark analyses of the cumulative risk of recurrence and death. Results: Among 4801 patients with HCC, we identified 426 patients who received resection and 544 who received ablation. The 2 treatment cohorts differed in cirrhosis prevalence and tumor stage. The 5-year recurrence risk was 40.7% (95% CI 35.5%−45.8%) following resection and 60.7% (95% CI: 55.9%−65.1%) following ablation. The 1-year recurrence risk decreased over the landmarks from 20.4% (95% CI: 16.6%−24.6%) at the time of resection to 4.7% (95% CI: 0.9%−13.9%) at the 5-year landmark. For ablation, the risk decreased from 36.1% (95% CI: 31.9%−40.4%) at the time of treatment to 5.3% (95% CI: 0.4%−21.4%) at the 5-year landmark. The risk of death without recurrence was stable over the landmarks following both resection and ablation. Conclusions: In conclusion, the risk of recurrence or death following resection or ablation for HCC is high from the treatment date, but the risk of recurrence decreases greatly over the survival landmarks. This information is valuable for clinicians and their patients.