Prognostic impact of tumor size on isolated hepatocellular carcinoma without vascular invasion may have age variance

Yi Zhang; Jun-Gang Zhang; Wei Yu; Lei Liang; Chun Wu; Cheng-Wu Zhang; Ya-Ming Xie; Dong-Sheng Huang; Ying Shi

doi:10.3389/fsurg.2022.988484

Prognostic impact of tumor size on isolated hepatocellular carcinoma without vascular invasion may have age variance

Front Surg. 2023 Jan 6:9:988484. doi: 10.3389/fsurg.2022.988484. eCollection 2022.

Authors

Yi Zhang^{1

2}, Jun-Gang Zhang^{2

3}, Wei Yu², Lei Liang², Chun Wu¹, Cheng-Wu Zhang², Ya-Ming Xie², Dong-Sheng Huang², Ying Shi⁴

Affiliations

¹ Zhejiang Provincial People's Hospital, Qingdao University, Hangzhou, China.
² General Surgery, Cancer Center, Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China.
³ Key Laboratory of Gastroenterology of Zhejiang Province, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China.
⁴ Obstetrics and Gynecology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China.

Abstract

Background: Previous studies suggested that tumor size was an independent risk factor of prognosis for hepatocellular carcinoma (HCC). However, the general prognostic analysis did not consider the interaction between variables. The purpose of this study was to investigate whether the effect of tumor size on the prognosis of isolated HCC without vascular invasion varies according to covariates.

Methods: Patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database to investigate whether there was an interaction between age and tumor size on the prognosis. Then the trend test and the value of per 1 SD of tumor size were calculated. In addition, the data of Zhejiang Provincial People's Hospital meeting the requirements were selected to verify the obtained conclusions.

Results: Multivariable Cox regression analysis of the database cohort showed that age, gender, tumor size, pathological grade and marital status were independent risk factors for prognosis. Interaction test showed that there was an interaction between age and tumor size (P for interaction < 0.05). Stratified analysis by age showed that tumor size was an independent risk factor for prognosis when age ≤65 years old (HR:1.010,95%CI1.007-1.013 P < 0.001), while tumor size was not an independent risk factor for prognosis when age >65 years old. This result was confirmed by trend analysis (P for trend < 0.001), and the prognostic risk increased by 42.1% for each standard deviation increase of tumor size among patients age ≤65 years. Consistent conclusion was obtained by multivariable cox regression analysis and interaction test on the verification cohort. In the validation cohort, for each standard deviation increase of tumor size in patients ≤65 years old, the risk of prognosis increased by 52.4%.

Conclusion: Tumor size is not an independent risk factor for the prognosis of isolated HCC without vascular invasion when patient's age >65 years. Therefore, when analyzing the relationship between tumor size and prognosis, stratified analysis should be performed according to age.

Keywords: P for interaction; P for trend; hepatocellular carcinoma; per 1 SD; tumor size.