Diamantis I Tsilimigras1, J Madison Hyer1, Adrian Diaz1, Fabio Bagante1,2, Francesca Ratti3, Hugo P Marques4, Olivier Soubrane5, Vincent Lam6, George A Poultsides7, Irinel Popescu8, Sorin Alexandrescu8, Guillaume Martel9, Aklile Workneh9, Alfredo Guglielmi2, Tom Hugh10, Luca Aldrighetti3, Itaru Endo11, Timothy M Pawlik1. 1. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA. 2. Department of Surgery, University of Verona, 37134 Verona, Italy. 3. Department of Surgery, Ospedale San Raffaele, 20132 Milano, Italy. 4. Department of Surgery, Curry Cabral Hospital, 1069-166 Lisbon, Portugal. 5. Department of Hepatobiliopancreatic Surgery, APHP, Beaujon Hospital, 92110 Clichy, France. 6. Department of Surgery, Westmead Hospital, Sydney 2145, Australia. 7. Department of Surgery, Stanford University, Stanford, CA 94305, USA. 8. Department of Surgery, Fundeni Clinical Institute, 022328 Bucharest, Romania. 9. Department of Surgery, University of Ottawa, Ottawa, ON K1H 8M5, Canada. 10. Department of Surgery, School of Medicine, The University of Sydney, Sydney 2006, Australia. 11. Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama 236-0004, Japan.
Abstract
INTRODUCTION: The prognostic role of tumor burden score (TBS) relative to pre-operative α -fetoprotein (AFP) levels among patients undergoing curative-intent resection of HCC has not been examined. METHODS: Patients who underwent curative-intent resection of HCC between 2000 and 2017 were identified from a multi-institutional database. The impact of TBS on overall survival (OS) and cumulative recurrence relative to serum AFP levels was assessed. RESULTS: Among 898 patients, 233 (25.9%) patients had low TBS, 572 (63.7%) had medium TBS and 93 (10.4%) had high TBS. Both TBS (5-year OS; low TBS: 76.9%, medium TBS: 60.9%, high TBS: 39.1%) and AFP (>400 ng/mL vs. <400 ng/mL: 48.5% vs. 66.1%) were strong predictors of outcomes (both p < 0.001). Lower TBS was associated with better OS among patients with both low (5-year OS, low-medium TBS: 68.0% vs. high TBS: 47.7%, p < 0.001) and high AFP levels (5-year OS, low-medium TBS: 53.7% vs. high TBS: not reached, p < 0.001). Patients with low-medium TBS/high AFP had worse OS compared with individuals with low-medium TBS/low AFP (5-year OS, 53.7% vs. 68.0%, p = 0.003). Similarly, patients with high TBS/high AFP had worse outcomes compared with patients with high TBS/low AFP (5-year OS, not reached vs. 47.7%, p = 0.015). Patients with high TBS/low AFP and low TBS/high AFP had comparable outcomes (5-year OS, 47.7% vs. 53.7%, p = 0.24). The positive predictive value of certain TBS groups relative to the risk of early recurrence and 5-year mortality after HCC resection increased with higher AFP levels. CONCLUSION: Both TBS and serum AFP were important predictors of prognosis among patients with resectable HCC. Serum AFP and TBS had a synergistic impact on prognosis following HCC resection with higher serum AFP predicting worse outcomes among patients with HCC of a certain TBS class.
INTRODUCTION: The prognostic role of tumor burden score (TBS) relative to pre-operative α -fetoprotein (AFP) levels among patients undergoing curative-intent resection of HCC has not been examined. METHODS:Patients who underwent curative-intent resection of HCC between 2000 and 2017 were identified from a multi-institutional database. The impact of TBS on overall survival (OS) and cumulative recurrence relative to serum AFP levels was assessed. RESULTS: Among 898 patients, 233 (25.9%) patients had low TBS, 572 (63.7%) had medium TBS and 93 (10.4%) had high TBS. Both TBS (5-year OS; low TBS: 76.9%, medium TBS: 60.9%, high TBS: 39.1%) and AFP (>400 ng/mL vs. <400 ng/mL: 48.5% vs. 66.1%) were strong predictors of outcomes (both p < 0.001). Lower TBS was associated with better OS among patients with both low (5-year OS, low-medium TBS: 68.0% vs. high TBS: 47.7%, p < 0.001) and high AFP levels (5-year OS, low-medium TBS: 53.7% vs. high TBS: not reached, p < 0.001). Patients with low-medium TBS/high AFP had worse OS compared with individuals with low-medium TBS/low AFP (5-year OS, 53.7% vs. 68.0%, p = 0.003). Similarly, patients with high TBS/high AFP had worse outcomes compared with patients with high TBS/low AFP (5-year OS, not reached vs. 47.7%, p = 0.015). Patients with high TBS/low AFP and low TBS/high AFP had comparable outcomes (5-year OS, 47.7% vs. 53.7%, p = 0.24). The positive predictive value of certain TBS groups relative to the risk of early recurrence and 5-year mortality after HCC resection increased with higher AFP levels. CONCLUSION: Both TBS and serum AFP were important predictors of prognosis among patients with resectable HCC. Serum AFP and TBS had a synergistic impact on prognosis following HCC resection with higher serum AFP predicting worse outcomes among patients with HCC of a certain TBS class.