Conditional survival after hepatic resection for hepatocellular carcinoma in cirrhotic patients
A partir de données cliniques portant sur 300 patients atteints d'une cirrhose et ayant subi une résection chirurgicale pour un carcinome hépatocellulaire, cette étude évalue l'intérêt d'utiliser le critère de survie conditionnelle à 5 ans pour améliorer la prise en charge des patients et les orienter vers un type de traitement
Purpose. Survival estimates are commonly reported as actuarial survival since the first observation, but future survival probabilities can change over time. Conditional survival (CS) is a measure of prognosis for patients who have already survived sometimes several years since diagnosis; however, data on CS for cirrhotic patients, resected for hepatocellular carcinoma (HCC), are lacking. Experimental Design. Clinical data from 300 consecutive cirrhotic patients who underwent HCC resection were reviewed and the actuarial survival estimated. The 5-year CS was calculated as CS=S(x+5)/S(x) and represents the probability of surviving an additional 5 years, given that the patient has already survived x years. Results. The 3-, 5-, and 10-year survival rates were, respectively, 69.0%, 57.7% and 25.3%, and were lower in cases of portal hypertension; MELD score (greater than or equal to)9; United-Network for Organ-Sharing T3-tumor; G3-G4 tumors and microscopic vascular invasion. However, the 5-year CS calculation showed that patients resected for more advanced (T3) tumors or with adverse histological features will experience the same survival probabilities as patients with less advanced tumors or favorable histology from the third year after surgery onwards, since they had probably escaped recurrence from intrahepatic metastases. Patients who underwent repeated hepatectomy for recurrence presented higher CS. Conclusions. CS showed that the impact of different variables influencing survival is not linear over time after hepatic resection. Information derived from CS can be used to better manage HCC patients, including the potential future setting of adjuvant therapies and the choice of listing, or not, for transplantation resected patients not recurring within 2 years.
Clinical Cancer Research , résumé, 2012