Analyzing the Interaction between Time to Surgery and Tumor Burden Score in Hepatocellular Carcinoma.

Abstract

Background: The impact of "Time to Surgery (TTS)" on outcomes for curative-intent hepatectomy in hepatocellular carcinoma (HCC) is debated. The interaction between Tumor Burden Score (TBS) and TTS remains unclear. This study evaluates how TBS and TTS affect long-term HCC outcomes.

Methods: HCC patients undergoing curative-intent hepatectomy (2000-2022) were analyzed from a multi-institutional database and categorized by TTS (≤ or >60 days). Overall survival (OS) and cancer-specific survival were assessed.

Results: Among 910 patients, median TTS was 22 days in the short TTS group (n=485) and 120 days in the long TTS group (n=425). The long TTS group was older with higher rates of ASA class>2, diabetes, and cirrhosis. Median TBS showed no significant difference between groups (4.61vs5.00). No significant 5-year OS difference was found (70.0%vs63.1%, P=0.05). Multivariable analysis identified TBS (HR:1.07[1.03-1.11], P<0.001), log AFP (HR:1.08[1.01-1.14], P=0.02), and ALBI score (HR:2.52[1.66-3.82], P<0.001) as significant; TTS was not (HR:1.18[0.78-1.77], P=0.43). Interaction analysis showed TBS as a significant risk factor in the short TTS group (HR:1.12[1.07-1.17], P<0.001), but not in the long TTS group (HR:0.98[0.91-1.05], P=0.56). In the low TBS group (≤5), higher mortality was observed in the long TTS group (5-year OS: 82.4%vs63.0%, P=0.001), a trend not seen in the high TBS group (57.9%vs63.3%, P=0.92). Multivariable analysis stratified by TBS found long TTS as a risk factor in the low TBS group (HR:3.12[1.60-6.01], P<0.001), but not in the high TBS group (HR:0.57[0.30-1.07], P=0.08). Similar trends were observed in cancer-specific survival.

Conclusion: While preoperative optimization is essential, minimizing TTS may improve outcomes in low TBS cohorts.