Cancer Res Treat.  2019 Oct;51(4):1347-1356. 10.4143/crt.2018.477.

Conditional Survival Estimates Improve Over Time for Patients with Hepatocellular Carcinoma: An Analysis for Nationwide Korea Cancer Registry Database

• Lee JS
• Cho IR
• Lee HW
• Jeon MY
• Lim TS
• Baatarkhuu O
• Kim DY
• Han KH
• Park JY

• KMID: 2460584
• DOI: http://doi.org/10.4143/crt.2018.477

Abstract

PURPOSE
Conditional survival estimates (CSE) can provide additional useful prognostic information on the period of survival after diagnosis, which helps in counseling patients with cancer on their individual prognoses. This study aimed to analyze conditional survival (CS) for hepatocellular carcinoma (HCC) using a Korean national registry.
MATERIALS AND METHODS
Patients with HCC, registered in the Korean cancer registry database, were retrospectively reviewed. Overall survival (OS) was calculated using the Kaplan-Meier method. The 1-year CS at X year or month after diagnosis were calculated as CS₁=OS((X+1))/OS((X)). CS calculations were performed in each Barcelona Clinic Liver Cancer stage, after which patients at stage 0, A, and B underwent subgroup analysis using initial treatment methods.
RESULTS
A total of 4,063 patients diagnosed with HCC from January 2008 to December 2010, and 2,721 who were diagnosed from January 2011 to December 2012, were separately reviewed. In 2008-2010, the 1-year CS of 1, 2, 3, 4, and 5-year survivors was 82.9%, 85.1%, 88.3%, 88.0%, and 88.6%, respectively. Patients demonstrated an increase in CSE over time in subgroup analysis, especially in the advanced stages. In 2011-2012, the 1-year CS of 6, 12, 18, 24, 30, and 36 months was 81.5%, 83.8%, 85.3%, 85.5%, 86.5%, and 88.8%, respectively. The subgroup analysis showed the same tendency towards increased CSE in the advanced stages.
CONCLUSION
Overall, the CS improved with each additional year after diagnosis in both groups. CSE may therefore provide a more accurate prognosis and hopeful message to patients who are surviving with or after treatment.

Keyword

Carcinoma; Hepatocellular; Conditional survival estimate; Survival; Prognosis; Demographic; Republic of Korea

MeSH Terms

Carcinoma, Hepatocellular*
Counseling
Diagnosis
Hope
Humans
Korea*
Liver Neoplasms
Methods
Prognosis
Republic of Korea
Retrospective Studies
Survivors

Figure

• 

  Fig. 1. Flow of selection of the study population. HCC, hepatocellular carcinoma; ICD-10, International Classification of Disease 10th edition; BCLC, Barcelona Clinic Liver Cancer; CSE, conditional survival estimate(s).

• 

  Fig. 2. Kaplan-Meier curves for cumulative survival rate of each Barcelona Clinic Liver Cancer (BCLC) stage in cohort A diagnosed in 2008-2010 (A) and cohort B diagnosed in 2011-2012 (B). Log-rank tests between any groups; p < 0.001.

• 

  Fig. 3. One-year conditional survival estimates of overall patients and each Barcelona Clinic Liver Cancer (BCLC) stage in cohort A diagnosed in 2008-2010 (A) and cohort B diagnosed in 2011-2012 (B). "X" yr or "X" mo, 1-year conditional survival estimates at the time of "X"-year or "X"-month survival.

• 

  Fig. 4. One-year conditional survival estimates of each Barcelona Clinic Liver Cancer (BCLC) subgroup using initial treatment methods in cohort A, in BCLC 0 (A), BCLC A (B), and BCLC B (C). "X" yr, 1-year conditional survival estimates at the time of "X"-year survival.

• 

  Fig. 5. One-year conditional survival estimates of each Barcelona Clinic Liver Cancer (BCLC) subgroup using initial treatment methods in cohort B, in BCLC 0 (A), BCLC A (B), and BCLC B (C). "X" yr or "X" mo, 1-year conditional survival estimates at the time of "X"-year or "X"-month survival.

Reference

References

1. McGlynn KA, Petrick JL, London WT. Global epidemiology of hepatocellular carcinoma: an emphasis on demographic and regional variability. Clin Liver Dis. 2015; 19:223–38.

2. Kim BH, Park JW. Epidemiology of liver cancer in South Korea. Clin Mol Hepatol. 2018; 24:1–9.

3. Yu SJ. A concise review of updated guidelines regarding the management of hepatocellular carcinoma around the world: 2010-2016. Clin Mol Hepatol. 2016; 22:7–17.

4. Terzi E, Golfieri R, Piscaglia F, Galassi M, Dazzi A, Leoni S, et al. Response rate and clinical outcome of HCC after first and repeated cTACE performed "on demand". J Hepatol. 2012; 57:1258–67.

5. Jung ES, Kim JH, Yoon EL, Lee HJ, Lee SJ, Suh SJ, et al. Comparison of the methods for tumor response assessment in patients with hepatocellular carcinoma undergoing transarterial chemoembolization. J Hepatol. 2013; 58:1181–7.

6. Henson DE, Ries LA. On the estimation of survival. Semin Surg Oncol. 1994; 10:2–6.

7. Hieke S, Kleber M, Konig C, Engelhardt M, Schumacher M. Conditional survival: a useful concept to provide information on how prognosis evolves over time. Clin Cancer Res. 2015; 21:1530–6.

8. Zheng MH, Wu SJ, Shi KQ, Yan HD, Li H, Zhu GQ, et al. Conditional survival estimate of acute-on-chronic hepatitis B liver failure: a dynamic prediction based on a multicenter cohort. Oncotarget. 2015; 6:23261–71.

9. Bischof DA, Kim Y, Dodson R, Jimenez MC, Behman R, Cocieru A, et al. Conditional disease-free survival after surgical resection of gastrointestinal stromal tumors: a multi-institutional analysis of 502 patients. JAMA Surg. 2015; 150:299–306.

10. Kim Y, Ejaz A, Spolverato G, Squires MH, Poultsides G, Fields RC, et al. Conditional survival after surgical resection of gastric cancer: a multi-institutional analysis of the us gastric cancer collaborative. Ann Surg Oncol. 2015; 22:557–64.

11. Sun M, Trinh QD, Karakiewicz PI. Conditional survival of patients with metastatic renal-cell carcinoma. Lancet Oncol. 2012; 13:e462.

12. Zabor EC, Gonen M, Chapman PB, Panageas KS. Dynamic prognostication using conditional survival estimates. Cancer. 2013; 119:3589–92.

13. Ferrell BR, Dow KH, Leigh S, Ly J, Gulasekaram P. Quality of life in long-term cancer survivors. Oncol Nurs Forum. 1995; 22:915–22.

14. Facciorusso A, Del Prete V, Antonino M, Neve V, Amoruso A, Crucinio N, et al. Conditional survival analysis of hepatocellular carcinoma patients treated with radiofrequency ablation. Hepatol Res. 2015; 45:E62–72.

15. Cucchetti A, Piscaglia F, Cescon M, Ercolani G, Terzi E, Bolondi L, et al. Conditional survival after hepatic resection for hepatocellular carcinoma in cirrhotic patients. Clin Cancer Res. 2012; 18:4397–405.

16. Cho IR, Lee HW, Song KJ, Kim BK, Kim SU, Kim DY, et al. Conditional survival estimate in patients with Barcelona Clinic Liver Cancer stage B/C hepatocellular carcinoma treated with hepatic arterial infusion chemotherapy with/without concurrent radiotherapy. Oncotarget. 2017; 8:79914–26.

17. Kim BK, Kim SU, Park JY, Kim DY, Ahn SH, Park MS, et al. Applicability of BCLC stage for prognostic stratification in comparison with other staging systems: single centre experience from long-term clinical outcomes of 1717 treatment-naive patients with hepatocellular carcinoma. Liver Int. 2012; 32:1120–7.

18. European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010; 53:397–417.

19. Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT. Hepatic encephalopathy-definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 2002; 35:716–21.

20. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973; 60:646–9.

21. Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000; 31:864–71.

22. Yu XQ, Baade PD, O'Connell DL. Conditional survival of cancer patients: an Australian perspective. BMC Cancer. 2012; 12:460.

23. Janssen-Heijnen ML, Gondos A, Bray F, Hakulinen T, Brewster DH, Brenner H, et al. Clinical relevance of conditional survival of cancer patients in europe: age-specific analyses of 13 cancers. J Clin Oncol. 2010; 28:2520–8.

24. Anderson C, Smitherman AB, Nichols HB. Conditional relative survival among long-term survivors of adolescent and young adult cancers. Cancer. 2018; 124:3037–43.

25. Chow PK, Choo SP, Ng DC, Lo RH, Wang ML, Toh HC, et al. National Cancer Centre Singapore consensus guidelines for hepatocellular carcinoma. Liver Cancer. 2016; 5:97–106.

26. Kitai S, Kudo M, Nishida N, Izumi N, Sakamoto M, Matsuyama Y, et al. Survival benefit of locoregional treatment for hepatocellular carcinoma with advanced liver cirrhosis. Liver Cancer. 2016; 5:175–89.

27. Kudo M. Heterogeneity and subclassification of Barcelona Clinic Liver Cancer Stage B. Liver Cancer. 2016; 5:91–6.

28. Yamakado K, Miyayama S, Hirota S, Mizunuma K, Nakamura K, Inaba Y, et al. Prognosis of patients with intermediate-stage hepatocellular carcinomas based on the Child-Pugh score: subclassifying the intermediate stage (Barcelona Clinic Liver Cancer stage B). Jpn J Radiol. 2014; 32:644–9.

29. Kudo M, Arizumi T, Ueshima K, Sakurai T, Kitano M, Nishida N. Subclassification of BCLC B stage hepatocellular carcinoma and treatment strategies: proposal of modified Bolondi's subclassification (Kinki Criteria). Dig Dis. 2015; 33:751–8.

30. Yau T, Tang VY, Yao TJ, Fan ST, Lo CM, Poon RT. Development of Hong Kong Liver Cancer staging system with treatment stratification for patients with hepatocellular carcinoma. Gastroenterology. 2014; 146:1691–700. e3.