Tumor burden score as a new prognostic marker for patients with hepatocellular carcinoma undergoing transarterial chemoembolization

Abstract

Background and Aim Size and number are major determinants of tumor burden in hepatocellular carcinoma (HCC). Patients with HCC undergoing transarterial chemoembolization (TACE) have variable outcomes due to heterogeneity of tumor burden. Recently, tumor burden score (TBS) was proposed to evaluate the extent of tumor involvement. However, the prognostic accuracy of TBS has not been well evaluated in HCC. This study aimed to assess its prognostic role in HCC patients undergoing TACE. Methods A total of 935 treatment‐naïve HCC patients receiving TACE were retrospectively analyzed. Multivariate Cox proportional hazards model was used to determine independent prognostic predictors. Results Tumor burden score tended to increase with increasing size and number of tumors in study patients. The Cox model showed that serum creatinine ≥ 1.2 mg/dL (hazard ratio [HR]: 1.296, 95% confidence interval [CI]: 1.077–1.559, P = 0.006), serum α‐fetoprotein ≥ 400 ng/dL (HR: 2.245, 95% CI: 1.905–2.645, P < 0.001), vascular invasion (HR: 1.870, 95% CI: 1.520–2.301, P < 0.001), medium TBS (HR: 1.489, 95% CI: 1.206–1.839, P < 0.001) and high TBS (HR: 2.563, 95% CI: 1.823–3.602, P < 0.001), albumin–bilirubin (ALBI) grade 2–3 (HR: 1.521, 95% CI: 1.291–1.792, P < 0.001), and performance status 1 (HR: 1.362, 95% CI: 1.127–1.647, P < 0.001) and status 2 (HR: 1.553, 95% CI: 1.237–1.948, P < 0.001) were associated with increased mortality. Patients with high TBS had poor overall survival in Barcelona Clinic Liver Cancer stage B/C and different ALBI grades. Conclusions Tumor burden score is a feasible new prognostic surrogate marker of tumor burden in HCC and can well discriminate survival in patients undergoing TACE across different baseline characteristics.

Tumor Burden Score Stratifies Prognosis of Patients With Intrahepatic Cholangiocarcinoma After Hepatic Resection: A Retrospective, Multi-Institutional Study

“…Tumor burden score (TBS), a new metric based on tumor size and tumor number, was firstly proposed for patients with colorectal liver metastases in 2017 ( 11 ). Recently, studies demonstrated that TBS also showed promising utility in stratifying prognosis of patients with hepatocellular carcinoma who underwent hepatectomy or liver transplantation ( 12 – 14 ). However, whether the prognosis of ICC patients could be dictated by TBS remained unclear.…”

Tumor Burden in Patients With Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: Head-to-Head Comparison of Current Scoring Systems

“…In a recent study, Ho et al. promoted the TBS as a novel tumor burden-related scoring system and a new prognostic marker for patients with HCC undergoing TACE ( 19 ). The TBS was originally developed in patients with colorectal liver metastasis undergoing resections ( 34 ).…”

“…For patients undergoing TACE, Ho et al. showed that the TBS could accurately discriminate risk stratifications for OS ( 19 ). However, subgroup analyses on patients within different BCLC stages and ALBI grades showed considerable overlap in the survival curves.…”

“…Standardized cut-offs for the laboratory parameters were derived from our laboratory database. Cut-off values for TBS, SAT and SEC were adopted from the original publications ( 13 , 19 , 20 ). The distributions of patients, according to TBS SAT and SEC, were compared with the Chi-Square test for categorial variables.…”

“…The TBS was originally developed for patients undergoing resections of colorectal liver metastasis. However, very recently, the TBS was successfully applied to stratify patients with HCC undergoing TACE ( 19 ).…”