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Tumor Burden Score and Serum Alpha-fetoprotein Subclassify Intermediate-Stage Hepatocellular Carcinoma

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Resection of Barcelona Clinic Liver Cancer (BCLC) intermediate-stage hepatocellular carcinoma (HCC) remains controversial. While not recommended by the BCLC algorithm, some patients may indeed benefit from hepatectomy. We sought to identify that subset of patients who might derive long-term survival benefit from resection.

Methods

Intermediate-stage HCC patients who underwent curative-intent resection were identified from an international multi-institutional database. Factors associated with long-term prognosis were identified using multivariate analysis and a risk score was developed and assessed.

Results

Among 194 patients, most individuals had two tumors (n = 123, 63.4%) with a median size of 6.0 cm (IQR, 4.0–8.4) for a median tumor burden score (TBS) of 6.5 (IQR, 5.0–9.1); median alpha-fetoprotein (AFP) was 23.9 ng/mL (IQR, 5.0–503.2), and median overall survival (OS) was 69 months (IAR, 60.7–77.3). Factors associated with OS included AFP (referent ≤ 20 ng/mL, > 20 ng/mL: HR 1.78 95%CI, 1.09–2.89) and TBS (referent TBS ≤ 8.0, TBS > 8.0: HR 1.72 95%CI, 1.07–2.75). While 71 (36.6%) patients had neither risk factor, 79 (40.7%) and 44 (22.7%) had 1 or 2, respectively. A simplified score stratified patients relative to recurrence-free survival (RFS) (0: 33.6% vs. 1: 18.0% vs. 2: 14.7%) (AUC 0.60) and recurrence time (i.e., < 6 months after surgery) (0: 21.3% vs. 1: 43.1% vs. 2: 68.6%) (AUC 0.69) (both p < 0.001). Of note, a higher score was also associated with incrementally worse 5-year OS (0: 68.1% vs. 1: 61.0% vs. 2: 29.9%) (AUC 0.62) (p < 0.001).

Conclusion

Long-term OS and RFS outcomes varied considerably. Using a simple risk score, patients with low AFP and low TBS were identified as the subset of individuals most likely to benefit from resection.

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Authors and Affiliations

  1. Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA

    Henrique A. Lima, Yutaka Endo, Laura Alaimo, Zorays Moazzam, Muhammad Musaab Munir, Chanza Shaikh & Timothy M. Pawlik

  2. Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil

    Henrique A. Lima & Vivian Resende

  3. Department of Surgery, University of Verona, Verona, Italy

    Laura Alaimo & Alfredo Guglielmi

  4. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal

    Hugo P. Marques

  5. Department of Hepatibiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France

    François Cauchy

  6. Department of Surgery, Westmead Hospital, Sydney, NSW, Australia

    Vincent Lam

  7. Department of Surgery, Stanford University, Stanford, CA, USA

    George A. Poultsides

  8. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania

    Irinel Popescu & Sorin Alexandrescu

  9. Department of Surgery, University of Ottawa, Ottawa, ON, Canada

    Guillaume Martel

  10. Department of Surgery, School of Medicine, The University of Sydney, Sydney, NSW, Australia

    Tom Hugh

  11. Yokohama City University School of Medicine, Yokohama, Japan

    Itaru Endo

  12. Department of Surgery, Keio University, Tokyo, Japan

    Minoru Kitago

  13. Eastern Hepatobiliary Surgery Hospital, Shanghai, China

    Feng Shen

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  1. Henrique A. Lima
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  20. Timothy M. Pawlik
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Correspondence to Timothy M. Pawlik.

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Lima, H.A., Endo, Y., Alaimo, L. et al. Tumor Burden Score and Serum Alpha-fetoprotein Subclassify Intermediate-Stage Hepatocellular Carcinoma. J Gastrointest Surg 26, 2512–2521 (2022). https://doi.org/10.1007/s11605-022-05469-9

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