Diamantis I Tsilimigras1, Rittal Mehta1, Alfredo Guglielmi2, Francesca Ratti3, Hugo P Marques4, Olivier Soubrane5, Vincent Lam6, George A Poultsides7, Irinel Popescu8, Sorin Alexandrescu8, Guillaume Martel9, Tom Hugh10, Luca Aldrighetti3, Itaru Endo11, Timothy M Pawlik1. 1. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio. 2. Department of Surgery, University of Verona, Verona, Italy. 3. Department of Surgery, Ospedale San Raffaele, Milano, Italy. 4. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal. 5. Department of Hepatobiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France. 6. Department of Surgery, Westmead Hospital, Sydney, Australia. 7. Department of Surgery, Stanford University, Stanford, California. 8. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania. 9. Department of Surgery, University of Ottawa, Ottawa, Canada. 10. Department of Surgery, School of Medicine, The University of Sydney, Sydney, Australia. 11. Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan.
Abstract
BACKGROUND: Accurate prediction of recurrence patterns of hepatocellular carcinoma (HCC) may allow for prioritization of patients for resection or transplantation as well as guide post-resection surveillance strategies. METHODS: Patients who underwent curative-intent R0 resection for HCC between 2000 and 2017 were identified using a multi-institutional database. A prognostic model that incorporated HCC tumor burden score (TBS) to predict recurrence beyond the Milan criteria (MC) was developed and validated. RESULTS: Among 718 patients who underwent R0 resection for HCC, 185 (25.8%) recurred within and 110 (15.3%) beyond the MC. On multivariable analysis, AFP more than 400 ng/mL (hazard ratio [HR] = 2.26; 95% confidence interval [CI]: 1.27-4.02), lymphovascular invasion (HR = 2.00; 95% CI: 1.14-3.50), and TBS (HR = 1.08; 95% CI: 1.03-1.12) were associated with recurrence beyond the MC. A weighted TBS-based score was constructed: [0.074*TBS + 0.692*lymphovascular invasion (yes: 1, no: 0) + 0.816*AFP > 400 (yes:1, no:0)]. Patients with a low, medium, and high TBS-based risk score had a 5-year incidence of recurring beyond the MC of 16.2%, 28.6%, and 47.2%, respectively (P < .001). The predictive accuracy of the model was very good in the training (C-index: 0.761) and validation (C-index: 0.706) datasets and outperformed the previously reported clinical risk score (CRS; C-index: 0.680). CONCLUSION: A TBS-based model accurately predicted recurrence beyond MC after curative-intent resection of HCC and outperformed the CRS. Incorporating TBS allows for better risk stratification and identifies patients in need of closer surveillance.
BACKGROUND: Accurate prediction of recurrence patterns of hepatocellular carcinoma (HCC) may allow for prioritization of patients for resection or transplantation as well as guide post-resection surveillance strategies. METHODS:Patients who underwent curative-intent R0 resection for HCC between 2000 and 2017 were identified using a multi-institutional database. A prognostic model that incorporated HCC tumor burden score (TBS) to predict recurrence beyond the Milan criteria (MC) was developed and validated. RESULTS: Among 718 patients who underwent R0 resection for HCC, 185 (25.8%) recurred within and 110 (15.3%) beyond the MC. On multivariable analysis, AFP more than 400 ng/mL (hazard ratio [HR] = 2.26; 95% confidence interval [CI]: 1.27-4.02), lymphovascular invasion (HR = 2.00; 95% CI: 1.14-3.50), and TBS (HR = 1.08; 95% CI: 1.03-1.12) were associated with recurrence beyond the MC. A weighted TBS-based score was constructed: [0.074*TBS + 0.692*lymphovascular invasion (yes: 1, no: 0) + 0.816*AFP > 400 (yes:1, no:0)]. Patients with a low, medium, and high TBS-based risk score had a 5-year incidence of recurring beyond the MC of 16.2%, 28.6%, and 47.2%, respectively (P < .001). The predictive accuracy of the model was very good in the training (C-index: 0.761) and validation (C-index: 0.706) datasets and outperformed the previously reported clinical risk score (CRS; C-index: 0.680). CONCLUSION: A TBS-based model accurately predicted recurrence beyond MC after curative-intent resection of HCC and outperformed the CRS. Incorporating TBS allows for better risk stratification and identifies patients in need of closer surveillance.
Authors: Laura Alaimo; Yutaka Endo; Henrique A Lima; Zorays Moazzam; Chanza Fahim Shaikh; Andrea Ruzzenente; Alfredo Guglielmi; Francesca Ratti; Luca Aldrighetti; Hugo P Marques; François Cauchy; Vincent Lam; George A Poultsides; Irinel Popescu; Sorin Alexandrescu; Guillaume Martel; Tom Hugh; Itaru Endo; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2022-09-13 Impact factor: 3.267