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Hepatocellular carcinoma tumour burden score to stratify prognosis after resection

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Title: Hepatocellular carcinoma tumour burden score to stratify prognosis after resection
Authors: Sorin Alexandrescu, Irinel Popescu, Alfredo Guglielmi, Guillaume Martel, Timothy M. Pawlik, A I Rodarte, Kazunari Sasaki, Demetrios Moris, Thomas J. Hugh, Luca Aldrighetti, Diamantis I. Tsilimigras, Silvia Silva, Itaru Endo, Francesca Ratti, Amika Moro, Hugo Marques, Fabio Bagante, Federico Aucejo, Anghela Z. Paredes, George A. Poultsides, Oliver Soubrane, Rittal Mehta, Kota Sahara, Aklile Workneh, J M Hyer, Vincent Lam
Source: British Journal of Surgery. 107:854-864
Publisher Information: Oxford University Press (OUP), 2020.
Publication Year: 2020
Subject Terms: Male, Carcinoma, Hepatocellular, Carcinoma, Hepatocellular / diagnosis, Carcinoma, Hepatocellular / surgery, Hepatocellular carcinoma, Liver Neoplasms / pathology, Kaplan-Meier Estimate, Liver Neoplasms / mortality, Disease-Free Survival, Neoplasm Staging / methods, 03 medical and health sciences, 0302 clinical medicine, Carcinoma, Hepatocellular / mortality, Humans, Aged, Neoplasm Staging, Carcinoma, Hepatocellular / pathology, Liver Neoplasms / surgery, Liver Neoplasms, Middle Aged, HCC CIR, Prognosis, Survival Analysis, Tumor Burden, 3. Good health, Liver Neoplasms / diagnosis, carcinoma, hepatocellular, neoplasms , Hepato-Pancreato-Biliary Surgery, Female
Description: 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.
Document Type: Article
File Description: application/pdf
Language: English
ISSN: 1365-2168
0007-1323
DOI: 10.1002/bjs.11464
Access URL: https://pubmed.ncbi.nlm.nih.gov/32057105
https://moh-it.pure.elsevier.com/en/publications/hepatocellular-carcinoma-tumour-burden-score-to-stratify-prognosi
https://pubmed.ncbi.nlm.nih.gov/32057105/
https://www.ncbi.nlm.nih.gov/pubmed/32057105
https://academic.oup.com/bjs/article/107/7/854/6094069
https://researchers.mq.edu.au/en/publications/hepatocellular-carcinoma-tumour-burden-score-to-stratify-prognosi
https://bjssjournals.onlinelibrary.wiley.com/doi/abs/10.1002/bjs.11464
https://academic.oup.com/bjs/article/107/7/854/6094069?login=true
https://doi.org/10.1002/bjs.11464
https://hdl.handle.net/20.500.11768/106319
http://hdl.handle.net/10400.17/4447
Rights: OUP Standard Publication Reuse
Accession Number: edsair.doi.dedup.....fd12fefb6701570dffd84d7ddd06ff1f
Database: OpenAIRE
Description
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.
ISSN:13652168
00071323
DOI:10.1002/bjs.11464