TY - JOUR
T1 - Variations in textbook oncologic outcomes after curative-intent resection
T2 - early versus intermediate hepatocellular carcinoma based on Barcelona clinic liver cancer criteria and Child-Pugh classification
AU - Moazzam, Zorays
AU - Alaimo, Laura
AU - Endo, Yutaka
AU - Lima, Henrique A.
AU - Shaikh, Chanza F.
AU - Ratti, Francesca
AU - Marques, Hugo P.
AU - Cauchy, François
AU - Lam, Vincent
AU - Poultsides, George A.
AU - Popescu, Irinel
AU - Alexandrescu, Sorin
AU - Martel, Guillaume
AU - Guglielmi, Alfredo
AU - Hugh, Tom
AU - Aldrighetti, Luca
AU - Endo, Itaru
AU - Pawlik, Timothy M.
PY - 2023/2
Y1 - 2023/2
N2 - Background: The impact of early versus intermediate hepatocellular carcinoma (HCC) on short-term “optimal” outcomes remains ill-defined. This study sought to define the incidence of textbook oncologic outcomes (TOO), as well as to identify factors associated with TOO among patients with early versus intermediate HCC. Methods: Patients who underwent curative-intent liver resection for HCC (1998–2020) were identified from a multi-institutional database. Textbook oncologic outcome (TOO) was defined as negative surgical margins, no return to the operating room, no extended hospital stay, no severe complications, and no 90-day mortality or readmission. Patients were stratified as early HCC (BCLC 0 or BCLC A/Child-Pugh A) or intermediate HCC (BCLC A/Child-Pugh B or BCLC B). Multivariate logistic regression analysis was used to assess factors associated with TOO. Results: Among 1383 patients, the overall incidence of TOO was 69.0%. Patients with intermediate HCC were less likely to achieve a TOO (early [71.6 %] vs. intermediate [60.1%]; p < 0.001). On multivariate analysis, factors associated with decreased odds of a TOO were high tumor burden (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.33-1.00), high aspartate transaminase-platelet ratio index (APRI) (OR, 0.46; 95% CI, 0.30–0.70), Charlson Comorbidity Index (CCI) greater than 3 (OR, 0.67; 95% CI, 0.49–0.91), major liver resection (OR, 0.68; 95% CI, 0.52–0.90), and intermediate HCC (OR, 0.68; 95% CI, 0.50–0.93) (all p < 0.05). Notably, although high APRI, CCI greater than 3, and major liver resection contributed to lower odds of a TOO in early HCC, the only factor that adversely impacted TOO in intermediate HCC was high tumor burden. Conclusions: Patients with intermediate HCC and early HCC patients with liver dysfunction, comorbidities, or an extensive resection were less likely to achieve an “optimal” postoperative outcome.
AB - Background: The impact of early versus intermediate hepatocellular carcinoma (HCC) on short-term “optimal” outcomes remains ill-defined. This study sought to define the incidence of textbook oncologic outcomes (TOO), as well as to identify factors associated with TOO among patients with early versus intermediate HCC. Methods: Patients who underwent curative-intent liver resection for HCC (1998–2020) were identified from a multi-institutional database. Textbook oncologic outcome (TOO) was defined as negative surgical margins, no return to the operating room, no extended hospital stay, no severe complications, and no 90-day mortality or readmission. Patients were stratified as early HCC (BCLC 0 or BCLC A/Child-Pugh A) or intermediate HCC (BCLC A/Child-Pugh B or BCLC B). Multivariate logistic regression analysis was used to assess factors associated with TOO. Results: Among 1383 patients, the overall incidence of TOO was 69.0%. Patients with intermediate HCC were less likely to achieve a TOO (early [71.6 %] vs. intermediate [60.1%]; p < 0.001). On multivariate analysis, factors associated with decreased odds of a TOO were high tumor burden (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.33-1.00), high aspartate transaminase-platelet ratio index (APRI) (OR, 0.46; 95% CI, 0.30–0.70), Charlson Comorbidity Index (CCI) greater than 3 (OR, 0.67; 95% CI, 0.49–0.91), major liver resection (OR, 0.68; 95% CI, 0.52–0.90), and intermediate HCC (OR, 0.68; 95% CI, 0.50–0.93) (all p < 0.05). Notably, although high APRI, CCI greater than 3, and major liver resection contributed to lower odds of a TOO in early HCC, the only factor that adversely impacted TOO in intermediate HCC was high tumor burden. Conclusions: Patients with intermediate HCC and early HCC patients with liver dysfunction, comorbidities, or an extensive resection were less likely to achieve an “optimal” postoperative outcome.
UR - http://www.scopus.com/inward/record.url?scp=85142246137&partnerID=8YFLogxK
U2 - 10.1245/s10434-022-12832-2
DO - 10.1245/s10434-022-12832-2
M3 - Article
C2 - 36404380
AN - SCOPUS:85142246137
SN - 1068-9265
VL - 30
SP - 750
EP - 759
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 2
ER -