Journal of Hepatocellular Carcinoma (Jul 2024)

Limited Generalizability of Retrospective Single-Center Cohort Study in Comparison to Multicenter Cohort Study on Prognosis of Hepatocellular Carcinoma

  • Kim YR,
  • Chung SW,
  • Kim MJ,
  • Choi WM,
  • Choi J,
  • Lee D,
  • Lee HC,
  • Shim JH

Journal volume & issue
Vol. Volume 11
pp. 1235 – 1249

Abstract

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Ye Rim Kim,1,2,* Sung Won Chung,1,2,* Min-Ju Kim,3 Won-Mook Choi,1,2 Jonggi Choi,1,2 Danbi Lee,1,2 Han Chu Lee,1,2 Ju Hyun Shim1,2,4 1Division of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; 2Liver Cancer Center, Asan Cancer Institute, Asan Medical Center, Seoul, Republic of Korea; 3Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; 4Digestive Diseases Research Center, University of Ulsan College of Medicine, Seoul, Republic of Korea*These authors contributed equally to this workCorrespondence: Ju Hyun Shim, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea, Tel +82-02-3010-3190, Fax +82-02-485-5782, Email [email protected]: We aimed to evaluate the generalizability of retrospective single-center cohort studies on prognosis of hepatocellular carcinoma (HCC) by comparing overall survival (OS) after various treatments between a nationwide multicenter cohort and a single-center cohort of HCC patients.Methods: Patients newly diagnosed with HCC between January 2008 and December 2018 were analyzed using data from the Korean Primary Liver Cancer Registry (multicenter cohort, n=16,443), and the Asan Medical Center HCC registry (single-center cohort, n=15,655). The primary outcome, OS after initial treatment, was compared between the two cohorts for both the entire population and for subcohorts with Child-Pugh A liver function (n=2797 and n=5151, respectively) treated according to the Barcelona-Clinic-Liver-Cancer (BCLC) strategy, using Log rank test and Cox proportional hazard models.Results: Patients of BCLC stages 0 and A (59.3% vs 35.2%) and patients who received curative treatment (42.1% vs 32.1%) were more frequently observed in the single-center cohort (Ps< 0.001). Multivariable analysis revealed significant differences between the two cohorts in OS according to type of treatment: the multicenter cohort was associated with higher risk of mortality among patients who received curative (adjusted hazard ratio [95% confidence interval], 1.48 [1.39– 1.59]) and non-curative (1.22 [1.17– 1.27]) treatments, whereas the risk was lower in patients treated with systemic therapy (0.83 [0.74– 0.92]) and best supportive care (0.85 [0.79– 0.91]). Subcohort analysis also demonstrated significantly different OS between the two cohorts, with a higher risk of mortality in multicenter cohort patients who received chemoembolization (1.72 [1.48– 2.00]) and ablation (1.44 [1.08– 1.92]).Conclusion: Comparisons of single-center and multicenter cohorts of HCC patients revealed significant differences in OS according to treatment modality after adjustment for prognostic variables. Therefore, the results of retrospective single-center cohort studies of HCC treatments may not be generalizable to real-world practice.Keywords: BCLC, UICC, liver cancer, retrospective cohort, external validation

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