Hepatocellular carcinoma tumour burden score to stratify prognosis after resection

Abstract

Background Although the Barcelona Clinic Liver Cancer (BCLC) staging system has been largely adopted in clinical practice, recent studies have emphasized the need for further refinement and subclassification of this system. Methods Patients who underwent hepatectomy with curative intent for BCLC‐0, ‐A or ‐B hepatocellular carcinoma (HCC) between 2000 and 2017 were identified using a multi‐institutional database. The tumour burden score (TBS) was calculated, and overall survival (OS) was examined in relation to TBS and BCLC stage. Results Among 1053 patients, 63 (6·0 per cent) had BCLC‐0, 826 (78·4 per cent) BCLC‐A and 164 (15·6 per cent) had BCLC‐B HCC. OS worsened incrementally with higher TBS (5‐year OS 77·9, 61 and 39 per cent for low, medium and high TBS respectively; P < 0·001). No differences in OS were noted among patients with similar TBS, irrespective of BCLC stage (61·6 versus 58·9 per cent for BCLC‐A/medium TBS versus BCLC‐B/medium TBS, P = 0·930; 45 versus 13 per cent for BCLC‐A/high TBS versus BCLC‐B/high TBS, P = 0·175). Patients with BCLC‐B HCC and a medium TBS had better OS than those with BCLC‐A disease and a high TBS (58·9 versus 45 per cent; P = 0·005). On multivariable analysis, TBS remained associated with OS among patients with BCLC‐A (medium TBS: hazard ratio (HR) 2·07, 95 per cent c.i. 1·42 to 3·02, P < 0·001; high TBS: HR 4·05, 2·40 to 6·82, P < 0·001) and BCLC‐B (high TBS: HR 3·85, 2·03 to 7·30; P < 0·001) HCC. TBS could also stratify prognosis among patients in an external validation cohort (5‐year OS 79, 51·2 and 28 per cent for low, medium and high TBS respectively; P = 0·010). Conclusion The prognosis of patients with HCC varied according to the BCLC stage but was largely dependent on the TBS.

Recurrence beyond the Milan criteria after curative‐intent resection of hepatocellular carcinoma: A novel tumor‐burden based prediction model

“…6,9,17 The use of a TBS-based score also allowed for the assessment of disease burden as continuous-rather than categorical-variable, thus allowing for a more granular prognostication of outcomes compared with the CRS. 15,16,30 In turn, by applying the formula provided in Table 2 The current study had several limitations that should be taken into consideration when interpreting the results. As with all retrospective studies, the current study was subject to selection bias.…”

“…TBS was defined as the distance from the origin of a Cartesian plane and comprised of two variables: maximum tumor size (x-axis) and number of tumors (y-axis) so that TBS 2 = (maximum tumor diameter) 2 + (number of tumors) 2 , as previously described. [15][16][17] In case of multiple nodules, tumor size was defined as the size of the largest lesion.…”

“…13,14 Our group recently reported that tumor burden score (TBS) could stratify long-term outcomes of patients undergoing resection for HCC. 15 Nevertheless, the utility of TBS to predict recurrence beyond MC has yet to be examined. As such, the objective of the current study was to assess the incidence of recurrence beyond the MC following curative-intent resection for HCC using an international, multi-institutional cohort.…”

“…Demographic and clinical data included age, sex, American Society of Anesthesiologists (ASA) class, history of cirrhosis, hepatitis B virus (HBV)/hepatitis C virus (HCV) infection, alpha-fetoprotein (AFP), type (ie, minimally invasive surgery [MIS] vs open) and extent of surgical resection (ie, minor or major), tumor differentiation grade, pathologic lymphovascular invasion, liver capsule involvement as well as primary tumor pathologic and radiologic TBS. Patients were categorized as having a low, medium, or high TBS based on the cut-off values previously reported (low TBS: <3.6, medium TBS: 3.6-13.74,high TBS: >13.74) 15. …”

Advances in liver surgery

“…The BJS hepatobiliary issue contains two prognostic scoring systems for HCC. The first, from Tsilimigras and colleagues in an international collaboration, assessed the ability of the HCC tumour burden score to stratify prognosis after resection in more than 1000 patients. The score is based on an equation derived from the sum of the squares of the maximum tumour diameter and total number of tumours, and was validated internally and against an external data set.…”