Long‐ versus short‐interval follow‐up after resection of hepatocellular carcinoma: a retrospective cohort study

Background Average postoperative follow‐up intervals vary in patients undergoing hepatocellular carcinoma (HCC) resection because of limited evidence regarding the optimal interval. We aimed to compare the associations of long‐versus short‐interval follow‐up with survival and recurrence in risk‐stratified HCC patients. Methods We performed a retrospective cohort study between 2007 and 2014. In total, 1227 patients treated by curative resection of Barcelona Clinic Liver Cancer stage A or B HCC were stratified as having a low (n = 865) or high (n = 362) risk of early recurrence (within the first 2 years after resection) based on prognostic factors identified by the least absolute shrinkage and selection operation algorithm. Patients were further classified into long‐interval (every 4–6 months) and short‐interval (every 2–4 months) follow‐up subgroups based on follow‐up within 2 years after resection (low risk, long vs. short: n = 390 vs. n = 475; high‐risk, long vs. short: n = 149 vs. n = 213). Results The short‐interval follow‐up did not prolong overall survival in either the low‐risk (hazard ratio [HR] = 1.152; 95% confidence interval [CI] 0.720–1.843) or high‐risk (HR = 1.213; 95% CI 0.702–2.094) patients. Early recurrence occurred in 401 patients. For high‐risk patients, the short‐interval follow‐up subgroup exhibited smaller intrahepatic recurrence than did the long‐interval group (2.6 vs. 3.5 cm, respectively, P = 0.045). However, no significant difference in the rate of Barcelona Clinic Liver Cancer stage 0/A recurrence was found between the long‐ and short‐interval follow‐up groups in either low‐ or high‐risk patients (63.1% vs. 68.2%, respectively, P = 0.580; 31.3% vs. 41.5%, respectively, P = 0.280). The rate of curative intent treatment for recurrence (34.5% vs. 39.7%, respectively, P = 0.430; 14.6% vs. 20.3%, respectively, P = 0.388) was also similar between the follow‐up groups for low‐ and high‐risk patients. Conclusions Shortening the postoperative follow‐up interval from every 4–6 months to every 2–4 months within the first 2 years after resection did not increase the rate of curative intent treatment or prolong the overall survival of patients with Barcelona Clinic Liver Cancer stage A or B HCC.