Table1_Surveillance Strategy for Barcelona Clinic Liver Cancer B Hepatocellular Carcinoma Achieving Complete Response: An Individualized Risk-Based Machine Learning Study.XLSX

Background: For patients with complete response (CR) of Barcelona Clinical Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC), there is no consensus regarding the monitoring strategy. Optimal surveillance strategies that can detect early progression of HCC within a limited visit after treatment have not yet been investigated. A retrospective, real-world study was conducted to investigate surveillance strategies for BCLC stage B HCC (BBHCC) patients with CR after curative treatment to support clinical decision making.
Methods: From January 2007 to December 2019, 546 BBHCC patients with CR after radical treatment were collected at Sun Yat-sen University Cancer Center. Seventy percent of patients were subjected to the train cohort randomly; the remaining patients comprised the validation cohort to verify the proposed arrangements. The random survival forest method was applied to calculate the disease progression hazard per month, and follow-up schedules were arranged to maximize the capability of progression detection at each visit. The primary endpoint of the study was the delayed-detection months for disease progression.
Results: The cumulative 1, 2, and 3-years risk-adjusted probabilities for the train/validation cohorts were 32.8%/33.7%, 54.0%/56.3%, and 64.0%/67.4%, respectively, with peaks around approximately the 9th month. The surveillance regime was primarily concentrated in the first year posttreatment. The delayed-detection months gradually decreased when the total follow-up times increased from 6 to 11. Compared with controls, our schedule reduced delayed detection. Typically, the benefits of our surveillance regimes were obvious when the patients were followed seven times according to our schedule. The optional schedules were 5, 7, 9, 11, 17, 23, and 30 months.
Conclusion: The proposed new surveillance schedule may provide a new perspective concerning follow-up for BBHCC patients with CR.

背景：对于巴塞罗那临床肝癌（Barcelona Clinical Liver Cancer, BCLC）分期B期肝细胞癌（hepatocellular carcinoma, HCC，以下简称BBHCC）获得完全缓解（complete response, CR）的患者，目前尚无统一的监测策略。目前尚未有研究探索能够在治疗后有限随访次数内早期检出肝癌进展的最优监测方案。本研究开展一项回顾性真实世界研究，旨在探讨根治性治疗后获得完全缓解的BBHCC患者的监测策略，以辅助临床决策制定。
方法：2007年1月至2019年12月，于中山大学肿瘤防治中心收集546例根治性治疗后获得完全缓解的BBHCC患者。将70%的患者随机纳入训练队列，剩余患者纳入验证队列以验证所提出的随访方案。本研究采用随机生存森林（random survival forest）方法计算每月的疾病进展风险率，并制定随访计划以最大化每次随访时的肿瘤进展检出效能。本研究的主要终点为疾病进展的延迟检测时长。
结果：训练队列/验证队列的1、2、3年累积风险调整后概率分别为32.8%/33.7%、54.0%/56.3%及64.0%/67.4%，峰值均出现在治疗后约第9个月。监测方案主要集中在治疗后第一年。随着总随访次数从6次增加至11次，延迟检测时长逐渐缩短。与对照组相比，本研究制定的随访方案可降低延迟检测风险。通常而言，当患者按照本方案完成7次随访时，监测获益最为显著。最优随访间隔为5、7、9、11、17、23及30个月。
结论：本研究提出的新型监测方案可为根治性治疗后获得完全缓解的BBHCC患者的随访管理提供新的思路。