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Validation of a supplementary condition of eighth AJCC staging system for stage II hepatocellular carcinoma

  • Author Footnotes
    1 Min Li and Linquan Wu and Shuaiwu Luo are contributed equally to this article.
    Min Li
    Footnotes
    1 Min Li and Linquan Wu and Shuaiwu Luo are contributed equally to this article.
    Affiliations
    Department of General Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, China
    Search for articles by this author
  • Author Footnotes
    1 Min Li and Linquan Wu and Shuaiwu Luo are contributed equally to this article.
    Linquan Wu
    Footnotes
    1 Min Li and Linquan Wu and Shuaiwu Luo are contributed equally to this article.
    Affiliations
    Department of General Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, China
    Search for articles by this author
  • Author Footnotes
    1 Min Li and Linquan Wu and Shuaiwu Luo are contributed equally to this article.
    Shuaiwu Luo
    Footnotes
    1 Min Li and Linquan Wu and Shuaiwu Luo are contributed equally to this article.
    Affiliations
    Department of General Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, China
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  • Yaran Liu
    Affiliations
    Department of Pharmacy, Nanchang University, No.999, University Avenue, Nanchang, 330006, China
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  • Chi Sun
    Affiliations
    Department of General Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, China
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  • Enliang Li
    Affiliations
    Department of General Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, China
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  • Jiakun Wang
    Affiliations
    Department of General Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, China
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  • Bowen Li
    Affiliations
    Department of General Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, China
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  • Zhihao Huang
    Affiliations
    Department of General Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, China
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  • Jin Ge
    Affiliations
    Department of General Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, China
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  • Jun Lei
    Affiliations
    Department of General Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, China
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  • Fan Zhou
    Affiliations
    Department of General Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, China
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  • Wenjun Liao
    Correspondence
    Corresponding author.
    Affiliations
    Department of General Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, China
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  • Author Footnotes
    1 Min Li and Linquan Wu and Shuaiwu Luo are contributed equally to this article.
Published:January 17, 2023DOI:https://doi.org/10.1016/j.ejso.2023.01.019

      Abstract

      Introduction

      The eighth American Joint Committee on Cancer (AJCC) staging system was flawed regarding the prognosis of stage II hepatocellular carcinoma (HCC). The aims of this study were to reveal the defect and make updates.

      Methods

      Clinical and survival data of HCC patients from the Surveillance, Epidemiology, and End Results database were used. We re-classified stage II into T2aN0M0 (tumors >2 cm with vascular invasion) and T2bN0M0 (multiple tumors ≤5 cm). The Kaplan–Meier method and log-rank test were used to estimate differences in overall survival (OS). Three propensity score matching analyses without (PSM1) or with (PSM2 and PSM3) consideration of surgical treatment were performed. Cox regression was used to reveal risk factors.

      Results

      HCC patients identified as T1bN0M0, T2aN0M0, T2bN0M0, and T3N0M0 were recruited. OS in T2N0M0 was consistent with the eighth AJCC staging system after PSM1. T2bN0M0 had increased OS compared with T2aN0M0 after PSM2 (hazard ratio [HR] = 1.36; 95% confidence interval [CI] = 1.06–1.73; P = 0.0141) or PSM3 (HR = 1.18; 95%CI = 1.01–1.37; P = 0.0283). No survival benefit existed between T1bN0M0 and T2bN0M0 after PSM2 (HR = 0.92; 95%CI = 0.80–1.05; P = 0.2171) or PSM3 (HR = 0.92; 95%CI = 0.84–1.01; P = 0.0888). Compared with T2aN0M0, T3N0M0 had shorter OS after PSM2 (HR = 0.64; 95%CI = 0.50–0.82; P = 0.0003) or PSM3 (HR = 0.63; 95%CI = 0.54–0.73; P < 0.0001). Cox regression analysis revealed that surgical treatment was associated with better prognosis (HR = 0.3; 95%CI = 0.3–0.4; P < 0.001).

      Conclusions

      The current staging for T2N0M0 is imprecise because surgical treatment is not adequately evaluated and would be ineffective if the proportion of T2bN0M0 patients with surgical treatment was increased.

      Keywords

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