A Prognostic Model To Predict Survival After Recurrence Among Patients With Recurrent Hepatocellular Carcinoma

Abstract

Objective: We sought to develop and validate a preoperative model to predict survival after recurrence (SAR) in hepatocellular carcinoma (HCC). Summary Background Data: Although HCC is characterized by rates of recurrence as high as 60%, models to predict outcomes after recurrence remain relatively unexplored. Methods: Patients who developed recurrent HCC between 2000-2020 were identified from an international multi-institutional database. Clinicopathologic data on primary disease, and laboratory and radiologic imaging data on recurrent disease were collected. Multivariable cox regression analysis and internal bootstrap validation (5,000 repetitions) were used to develop and validate the SARScore. Optimal Survival Tree (OST) analysis was used to characterize SAR among patients treated with various treatment modalities. Results: Among 497 patients who developed recurrent HCC, median SAR was 41.2 months (95% CI 38.1–52.0). Presence of cirrhosis, number of primary tumors, primary macrovascular invasion, primary R1 resection margin, AFP>400 ng/mL on diagnosis of recurrent disease, radiologic extrahepatic recurrence, radiologic size and number of recurrent lesions, radiologic recurrent bilobar disease and early recurrence (≤24 months) were included in the model. The SARScore successfully stratified 1-, 3- and 5-year SAR and demonstrated strong discriminatory ability (3-year AUC: 0.75, 95% CI 0.70–0.79). While a subset of patients benefitted from resection/ablation, OST analysis revealed that patients with high SARScore disease had the worst outcomes (5-year AUC; training: 0.79 vs. testing: 0.71). The SARScore model was made available online for ease-of-use and clinical applicability (https://yutaka-endo.shinyapps.io/SARScore/). Conclusion: The SARScore demonstrated strong discriminatory ability and may be a clinically useful tool to help stratify risk and guide treatment for patients with recurrent HCC.

Application of artificial intelligence to hepatobiliary cancer clinical outcomes research

“…The decisionmaking process becomes even more complex in the retreatment of patients with recurrent lesions post initial liver resection, as many different multidisciplinary approaches need to be considered [36] . To this end, some researchers have sought to establish optimal treatment ML algorithms to inform the care of these patients [37,38] . For example, Famularo et al examined an Italian registry of patients with HCC and an external Japanese cohort to develop and validate a prediction model related to survival after recurrence (SAR) [37] .…”

“…To this end, some researchers have sought to establish optimal treatment ML algorithms to inform the care of these patients [37,38] . For example, Famularo et al examined an Italian registry of patients with HCC and an external Japanese cohort to develop and validate a prediction model related to survival after recurrence (SAR) [37] . This model, based on a standard Cox model that incorporated all second-order interactions of treatment with features selected by the Least Absolute Shrinkage and Selection Operator (LASSO) [39] , included treatment-related variables and time to recurrence.…”

“…The resulting ML-based model demonstrated high predictive ability, as shown by the area under the curve (AUC) values (3-year SAR: AUC 0.805; 5-year SAR: AUC 0.785). The authors concluded that an ML-based model could assist in allocating treatment for patients with recurrent HCC [37] . Another study by our own research group utilized an international, multi- 2023 Intrahepatic cholangiocarcinoma Prediction of survival and recurrence relative to margin width…”

Is Cell-Free DNA Testing in Hepatocellular Carcinoma Ready for Prime Time?

“…The 5-year survival rate is around 75% in early-stage tumors and 35% in intermediate/advanced-stage tumors (median overall survival (OS) of 37 m) [ 5 , 7 ]. Median progression-free survival (PFS) after surgery is around 9 months, and 38% recur in less than 2 years [ 8 ]. Post-recurrence 5-year survival rate is around 43% and current evidence does not justify the use of adjuvant (AT) or neoadjuvant (NAT) as standard-of-care (SOC).…”

Impact of hepatic inflammation and fibrosis on the recurrence and long-term survival of hepatitis B virus-related hepatocellular carcinoma patients after hepatectomy

“…While the impact of cirrhosis on the long-term survival of patients with HCC remained inconsistent. Some studies reported that the long-term prognosis of patients with HCC and cirrhosis was worse than that of those without cirrhosis [14,15]. However, high-quality studies have reported no signi cant difference in the prognosis between HCC patients with cirrhosis and without cirrhosis [4,16,17].…”