Impact of tumor burden score on timing and patterns of recurrence after curative-intent resection of hepatocellular carcinoma

Moazzam, Zorays; Lima, Henrique A.; Alaimo, Laura; Endo, Yutaka; Shaikh, Chanza; Ratti, Francesca; Soubrane, Olivier; Lam, Vincent; Poultsides, George A.; Popescu, Irinel; Alexandrescu, Sorin; Martel, Guillaume; Guglielmi, Alfredo; Hugh, Tom; Aldrighetti, Luca; Endo, Itaru; Pawlik, Timothy M.

doi:10.1016/j.surg.2022.07.019

Cited by 19 publications

(17 citation statements)

References 33 publications

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“…23 Despite being the treatment of choice for patients with resectable HCC and well-preserved liver function, liver resection has been associated with a 5-year incidence of recurrence as high as 60%. [5][6][7] In turn, recurrent disease can adversely impact long-term survival, as well as have a detrimental effect on patient quality of life. 8 In fact, a landmark study by Poon et al concluded that the development of recurrence is the most important factor contributing to the deteriorating quality of life among patients who undergo resection for HCC.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Although liver resection is recommended as standard treatment for patients with resectable HCC and preserved liver function, the incidence of 5-year recurrence can be as high as 40% to 60%. [5][6][7] In turn, HCC recurrence can adversely impact long-term survival outcomes as well as patient quality of life. 8 As such, there has been considerable interest in the development of tools that can predict survival after recurrence (SAR) in HCC, as well as help identify subgroups of patients that can derive a SAR benefit relative to different treatment options.…”

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confidence: 99%

“…Furthermore, the incidence of HCC-specific mortality has been projected to increase rapidly until at least 2030 in the United States 3,4 . Although liver resection is recommended as standard treatment for patients with resectable HCC and preserved liver function, the incidence of 5-year recurrence can be as high as 40% to 60% 5–7 . In turn, HCC recurrence can adversely impact long-term survival outcomes as well as patient quality of life 8 .…”

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confidence: 99%

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

et al. 2023

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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.

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

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“…9 The TBS is simple to use, and numerous studies have shown its predictive value in prognosing patients with HCC undergoing LR. [10][11][12][13][14][15][16][17][18][19][20][21] Of these studies, Lima et al developed a preoperative model comprising radiographic TBS, AFP, and Child − Pugh (CP) classi cation. This model was superior to the BCLC staging system in predicting OS and further strati ed patients within each BCLC stage relative to OS.…”

Section: Introductionmentioning

confidence: 99%

A radiographic tumor burden score-based preoperative model to predict overall survival in patients with hepatocellular carcinoma undergoing resection

Moi

Liu

et al. 2023

Preprint

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Purpose Tumor size, number, alpha-fetoprotein (AFP), and cirrhosis are well-known prognostic factors in patients with hepatocellular carcinoma (HCC) undergoing liver resection (LR). We aimed to develop a preoperative model to predict overall survival (OS) in these patients based on these variables.Methods Patients who underwent LR for Barcelona Clinic Liver Cancer (BCLC) stage 0, A, or B HCC were enrolled.Results Among 743 enrolled patients, 193 (26.0%) patients had a low tumor burden score (TBS) (< 2.6), 474 (63.8%) had a medium TBS (2.6–7.9), and 75 (10.1%) had a high TBS (> 7.9). Multivariate analysis showed that TBS (low: referent; medium: HR = 2.91; 95% CI: 1.62–5.24; p < 0.001; high, HR = 7.73; 95% CI: 3.90–15.3; p < 0.001), AFP (< 400 ng/mL: referent; ≧400 ng/mL: HR = 1.64, 95% CI: 1.10 − 2.45, p = 0.015), and cirrhosis (absence: referent; presence: HR = 1.88, 95% CI: 1.30–2.73, p < 0.001) were associated with OS. A simplified risk score was superior to BCLC in concordance index (0.688 vs. 0.617), Akaike information criteria (1438 vs. 1466), and homogeneity (57.5 vs. 31.6). It also further stratified patients within each BCLC group relative to five-year OS: BCLC 0: very low = 95%, and low = 78%; BCLC A: very low = 93%, low = 79%, medium = 63%, and high = 52%; and BCLC B: low = 82%, medium = 38%, and high = 21%.Conclusion We have developed a simple preoperative model that performs better in predicting OS than the BCLC system.

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“…In contrast, liver resection makes a negligible prognostic impact on a part of CRLM, despite being resectable. A number of retrospective studies identified factors associated with early recurrence or poor prognosis after curative liver resection for CRLM [4, 5]. However, we do not currently have a consensus on preoperatively available factors prohibiting surgical treatment for resectable CRLM.…”

Section: Introductionmentioning

confidence: 99%

Objective Definition and Optimized Strategy for “Biologically Borderline Resectable” Colorectal Liver Metastases

et al. 2023

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Background The prognostic benefit of preoperative chemotherapy leading to conversion surgery for unresectable colorectal liver metastases (CRLM) is well recognized, while that of neoadjuvant chemotherapy (NAC) compared with upfront surgery (UFS) for resectable CRLM is negligible. This study aims to assess the prognostic benefit and search for optimal indication of NAC for resectable advanced CRLM by establishing an objective definition of biologically borderline resectable (bBR) CRLM. Methods A bicentric retrospective analysis of patients with CRLM undergoing curative-intent initial liver resection between 2007 and 2021 was performed. An original classification matrix was established, which reassessed technical resectability using virtual hepatectomy and oncological favorability using Beppu's nomogram. Patients with technically resectable but biologically unfavorable CRLM were classified into the bBR group. The propensity score matching analysis using preoperatively available factors was performed to assess long-term outcomes of the bBR-UFS and bBR-NAC groups. Results Of 831 patients reviewed, 240 were categorized into the bBR group: bBR -UFS (n = 139) and bBR-NAC (n = 101). Ten (10%) in the bBR-NAC group (n = 101) experienced biological status change from unfavorable to favorable after NAC (Biological Conversion) and showed significantly longer overall survival (hazard ratio 5.63, 95% confidence interval 1.37-23.1; P = 0.016) than the bBR-UFS group. However, after propensity score matching, no significant difference between the UFS and NAC groups (n = 67 for each) was found in long-term outcomes. Conclusions NAC for bBR-CRLM did not enhance the prognostic impact of the following liver resection, except for a limited number of optimal candidates experiencing the Biological Conversion.

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Impact of tumor burden score on timing and patterns of recurrence after curative-intent resection of hepatocellular carcinoma

Cited by 19 publications

References 33 publications

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

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

A radiographic tumor burden score-based preoperative model to predict overall survival in patients with hepatocellular carcinoma undergoing resection

Objective Definition and Optimized Strategy for “Biologically Borderline Resectable” Colorectal Liver Metastases

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