Author(s):
Lima, H ; Endo, Y ; Moazzam, Z ; Alaimo, L ; Shaikh, C ; Munir, M ; Resende, V ; Guglielmi, A ; Pinto Marques, H ; Cauchy, F ; Lam, V ; Poultsides, G ; Popescu, I ; Alexandrescu, S ; Martel, G ; Endo, I ; Kitago, M ; Shen, F ; Pawlik, T
Date: 2023
Persistent ID: http://hdl.handle.net/10400.17/4965
Origin: Repositório do Centro Hospitalar de Lisboa Central, EPE
Subject(s): HCC CIR; Carcinoma, Hepatocellular* / pathology; Hepatectomy; Humans; Liver Neoplasms* / pathology; Neoplasm Staging; Prognosis; Retrospective Studies; alpha-Fetoproteins
Description
Background: Heterogeneity in hepatocellular carcinoma (HCC) still exists within the Barcelona clinic liver cancer (BCLC) subcategories. We developed a simple model to better discriminate and predict prognosis following resection. Methods: Patients who underwent curative-intent resection for HCC were identified from a multi-institutional database. Predictive factors of survival were identified to develop TAC (tumor burden score [TBS], alpha-fetoprotein [AFP], Child-Pugh CP]) score. Results: Among 1435 patients, median TBS was 5.1 (interquartile range [IQR]: 3.2-8.1), median AFP was 18.3 ng/ml (IQR 4.0-362.5), and 1391 (96.9%) patients were classified as CP-A. Factors associated with overall survival (OS) included TBS (low: referent; medium: HR 2.26, 95% CI: 1.73-2.96; high: HR = 3.35, 95% CI: 2.22-5.07), AFP (<400 ng/ml: referent; >400 ng/ml: HR = 1.56, 95% CI: 1.27-1.92), and CP (A: referent; B: HR = 1.81, 95% CI: 1.12-2.92) (all p < 0.05). A simplified risk score demonstrated superior concordance index, Akaike information criteria, homogeneity, and area under the curve versus BCLC (0.620 vs. 0.541; 5484.655 vs. 5536.454; 60.099 vs. 16.194; 0.62 vs. 0.55, respectively), and further stratified patients within BCLC groups relative to OS (BCLC 0, very low: 86.8%, low: 47.8%) (BCLC A, very low: 79.7%, low: 68.1%, medium: 52.5%, high: 35.6%) (BCLC B, low: 59.8%, medium: 43.7%, high: N/A). Conclusion: TAC is a simple, holistic score that consistently outperformed BCLC relative to discrimination power and prognostication following resection of HCC.
