Recurrence-free survival as a predictor of overall survival among patients with early-stage hepatocellular carcinoma treated with surgical resection or local ablation

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Background This study describes clinical outcomes of patients with hepatocellular carcinoma (HCC) and evaluates the association between real-world recurrence-free survival (rwRFS) and real-world overall survival (rwOS). Methods Patients with HCC who had no evidence of disease or treatment within 30 days of surgical resection or local ablation in the Surveillance, Epidemiology and End Results (SEER)-Medicare database (2007–2017) were included. Kendall's tau was used to estimate the correlation between rwRFS and rwOS. Landmark analysis was conducted to compare rwOS between patients who did or did not experience recurrence by certain time points using adjusted Cox proportional hazards models. Time-to-event analyses were conducted using Kaplan-Meier method. Long-term survivorship analysis was conducted to compare OS in patients with HCC to the general US population (age-sex matched/adjusted) using one-sample log-rank tests. Results Among 611 patients, the average (median) follow-up duration was 3.3 (2.6) years, during which 404 (66.1%) patients experienced recurrence or death. Median rwRFS was 1.8 (95% CI: 1.6, 2.1) years and median rwOS was 4.6 (95% CI: 4.0, 5.9) years. Kendall's tau between rwRFS and rwOS was 0.66 (95% CI: 0.60, 0.70; p<0.01). The risk of death among patients with vs without disease recurrence was significantly higher at 6 months and 1, 2, and 3 years. Achieving RFS for ≥3 years significantly reduced the risk of death, with survival expected to be similar to the general US population. Conclusions rwRFS and rwOS were significantly and positively correlated, suggesting that RFS may be relevant in assessing the long-term efficacy in this population.

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