Adjuvant radiotherapy in central hepatocellular carcinoma after narrow-margin hepatectomy: A 10-year real-world evidence

Weiqi Rong; Weibo Yu; Liming Wang; Fan Wu; Kai Zhang; Bo Chen; Chengli Miao; Liguo Liu; Songlin An; Changcheng Tao; Weihu Wang; Jianxiong Wu

doi:10.21147/j.issn.1000-9604.2020.05.09

Adjuvant radiotherapy in central hepatocellular carcinoma after narrow-margin hepatectomy: A 10-year real-world evidence

Chin J Cancer Res. 2020 Oct 31;32(5):645-653. doi: 10.21147/j.issn.1000-9604.2020.05.09.

Authors

Weiqi Rong¹, Weibo Yu², Liming Wang¹, Fan Wu¹, Kai Zhang¹, Bo Chen³, Chengli Miao⁴, Liguo Liu⁵, Songlin An⁶, Changcheng Tao¹, Weihu Wang⁷, Jianxiong Wu¹

Affiliations

¹ Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
² Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA.
³ Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
⁴ Department of Retroperitoneal Tumor Surgery, Peking University International Hospital, Beijing 102206, China.
⁵ Department of General Surgery, China-Japan Friendship Hospital, Beijing 100029, China.
⁶ Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University Beijing, Beijing 100038, China.
⁷ Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China.

PMID: 33223759
PMCID: PMC7666779
DOI: 10.21147/j.issn.1000-9604.2020.05.09

Abstract

Objective: A prospective randomized control study investigated the feasibility and efficacy of adjuvant radiotherapy on patients with central hepatocellular carcinoma (HCC) after narrow-margin hepatectomy (<1 cm). This study presents an updated 10-year real-world evidence to further characterize the role of adjuvant radiotherapy.

Methods: Patients with central HCC after narrow-margin hepatectomy (<1 cm) were prospectively assigned to adjuvant radiotherapy group and control group. Patients' outcome, adverse events, long-term recurrence and survival rates were investigated.

Results: The 1-, 5-, and 10-year recurrence-free survival (RFS) rates were 81.0%, 43.9%, and 38.7%, respectively in adjuvant radiotherapy group and 71.7%, 35.8%, and 24.2%, respectively in control group (log-rank test, P=0.09). The 1-, 5-, and 10-year overall survival (OS) rates were 96.6%, 54.7%, and 42.8%, respectively in adjuvant radiotherapy group and 90.2%, 55.1%, and 30.0%, respectively in control group (log-rank test, P=0.20). The 1-, 5-, and 10-year RFS rates for patients with small HCC (≤5 cm) were 91.1%, 51.6%, and 48.4%, respectively in adjuvant radiotherapy group and 80.0%, 36.6%, and 26.6%, respectively in control group (log-rank test, P=0.03). Landmark analysis demonstrated that patients with small HCC in adjuvant radiotherapy group had a significantly improved OS in second five years after treatment in comparison to patients in control group (log-rank test, P=0.05).

Conclusions: Our updated results showed a sustained clinical benefit on reducing recurrence, improving long-term survival for small central HCC by adjuvant radiotherapy after narrow-margin hepatectomy. Long-term survival data also indicated that hepatectomy is an optimal treatment for selected patients with central HCC.

Keywords: Three-dimensional conformal radiotherapy; long-term survival; narrow-margin hepatectomy; real-world evidence; recurrence.