Impact of Tumor Burden Score on Conditional Survival after Curative‐Intent Resection for Hepatocellular Carcinoma: A Multi‐Institutional Analysis

Abstract

Background The impact of tumor burden score (TBS) on conditional survival (CS) among patients undergoing curative-intent resection of hepatocellular carcinoma (HCC) has not been examined to date. Methods Patients who underwent liver resection of HCC between 2000 and 2017 were identified from a multiinstitutional database. The impact of TBS and other clinicopathologic factors on 3-year conditional survival (CS 3 ) was examined. Results Among 1,040 patients, 263 (25.3%) patients had low TBS, 668 (64.2%) had medium TBS and 109 (10.5%) had high TBS. TBS was strongly associated with OS; 5-year OS was 39.0% among patients with high TBS compared with 61.1% and 79.4% among patients with medium and low TBS, respectively (p \ 0.001). While actuarial survival decreased as time elapsed from resection, CS increased over time irrespective of TBS. The largest differences between 3-year actuarial survival and CS 3 were noted among patients with high TBS (5-years postoperatively; CS 3 : 78.7% vs. 3-year actuarial survival: 30.7%). The effect of adverse clinicopathologic factors including high TBS, poor/undifferentiated tumor grade, microvascular invasion, liver capsule involvement, and positive margins on prognosis decreased over time. Conclusions CS rates among patients who underwent resection for HCC increased as patients survived additional years, irrespective of TBS. CS estimates can be used to provide important dynamic information relative to the changing survival probability after resection of HCC.

Development of a clinical scoring model to predict the overall and relapse‑free survival of patients with hepatocellular carcinoma following a hepatectomy

“…Currently, surgery is considered the best candidate therapy for patients with solitary HCC, while the prognostic staging of HCC following curative hepatectomy remains a challenge; although several staging systems have been proposed, none have been universally adopted, since HCC is heterogeneous and is influenced by tumor burden ( 11 ), viral infections ( 12 ), liver function ( 13 ), immune response ( 14 ) and metabolic abnormalities ( 15 ). An ideal prognostic model for risk stratification needs to be developed with appropriate methods.…”

Dynamic Prediction of Survival After Curative Resection of Intrahepatic Cholangiocarcinoma: A Landmarking-Based Analysis

“…Traditionally based solely on factors obtained at the time of diagnosis/surgery, standard survival estimates rely on static rather than dynamic measures of long-term survival. 8,9 In addition, survival estimates often aggregate data into prognostic groups, which may be helpful for the general prediction of survival, but may not be as applicable to determine the prognosis of an individual patient. 10 In particular, although they are a powerful tool, survival analyses also are vulnerable to a number of biases, which can lead to biased conclusions.…”

Conditional survival after radiofrequency ablation for early-stage hepatocellular carcinoma

“…6 Multiple studies have reported changes over time in the CS of patients undergoing resection for HCC. [7][8][9][10] However, only one study reported the CS of patients undergoing RFA for HCC. 7 It enrolled patients with Child-Pugh class B liver disease.…”