Skip to main content
SpringerLink
Log in

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

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

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 multi-institutional database. The impact of TBS and other clinicopathologic factors on 3-year conditional survival (CS3) 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 CS3 were noted among patients with high TBS (5-years postoperatively; CS3: 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Jemal A, Ward EM, Johnson CJ, et al (2017) Annual Report to the Nation on the Status of Cancer, 1975–2014, Featuring Survival. J Natl Cancer Inst 109

  2. Kulik L, El-Serag HB (2019) Epidemiology and management of hepatocellular carcinoma. Gastroenterology 156:477–491

    Article  Google Scholar 

  3. White DL, Thrift AP, Kanwal F et al (2017) Incidence of hepatocellular carcinoma in all 50 United States, from 2000 through 2012. Gastroenterology 152:812–820

    Article  Google Scholar 

  4. Tsilimigras DI, Bagante F, Moris D et al (2019) Defining the chance of cure after resection for hepatocellular carcinoma within and beyond the Barcelona clinic liver cancer guidelines: a multi-institutional analysis of 1010 patients. Surgery 166:967–974

    Article  Google Scholar 

  5. Pinna AD, Yang T, Mazzaferro V et al (2018) Liver transplantation and hepatic resection can achieve cure for hepatocellular carcinoma. Ann Surg 268:868–875

    Article  Google Scholar 

  6. European Association for the Study of the Liver (2018) Electronic address eee, european association for the study of the L EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 69:182–236

    Article  Google Scholar 

  7. Amin MB, Greene FL, Edge SB, et al (2017) The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA: A Cancer J Clin. 67:93-99

  8. Tsilimigras DI, Moris D, Hyer JM et al (2020) Hepatocellular carcinoma tumour burden score to stratify prognosis after resection. Br J Surg 107:854–864

    Article  CAS  Google Scholar 

  9. Shah MM, Meyer BI, Rhee K et al (2020) Conditional survival analysis of hepatocellular carcinoma. J Surg Oncol 122(4):684–690

    Article  Google Scholar 

  10. Kurta ML, Edwards RP, Moysich KB et al (2014) Prognosis and conditional disease-free survival among patients with ovarian cancer. J Clin Oncol 32:4102–4112

    Article  Google Scholar 

  11. Spolverato G, Kim Y, Ejaz A et al (2015) Conditional probability of long-term survival after liver resection for intrahepatic cholangiocarcinoma: a multi-institutional analysis of 535 patients. JAMA Surg 150:538–545

    Article  Google Scholar 

  12. Hieke S, Kleber M, Konig C et al (2015) Conditional survival: a useful concept to provide information on how prognosis evolves over time. Clin Cancer Res 21:1530–1536

    Article  Google Scholar 

  13. Park YK, Song SK, Kim BW et al (2017) Conditional survival analysis demonstrates that recurrence risk of surgically treated hepatocellular carcinoma evolves with time. J Gastrointest Surg 21:1237–1244

    Article  Google Scholar 

  14. Cucchetti A, Piscaglia F, Cescon M et al (2012) Conditional survival after hepatic resection for hepatocellular carcinoma in cirrhotic patients. Clin Cancer Res 18:4397–4405

    Article  Google Scholar 

  15. Sasaki K, Morioka D, Conci S et al (2018) The tumor burden score: a new, “metro-ticket” prognostic tool for colorectal liver metastases based on tumor size and number of tumors. Ann Surg 267:132–141

    Article  Google Scholar 

  16. Strasberg SM (2005) Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg 12:351–355

    Article  Google Scholar 

  17. Buettner S, Margonis GA, Kim Y et al (2016) Conditional probability of long-term survival after resection of hilar cholangiocarcinoma. HPB (Oxford) 18:510–517

    Article  Google Scholar 

  18. Beal EW, Tumin D, Kabir A et al (2017) Trends in the mortality of hepatocellular carcinoma in the United States. J Gastrointest Surg 21:2033–2038

    Article  Google Scholar 

  19. Lafaro KJ, Demirjian AN, Pawlik TM (2015) Epidemiology of hepatocellular carcinoma. Surg Oncol Clin N Am 24:1–17

    Article  Google Scholar 

  20. Llovet JM, Bruix J (2008) Novel advancements in the management of hepatocellular carcinoma in 2008. J Hepatol 48(Suppl 1):S20-37

    Article  CAS  Google Scholar 

  21. Yu SJ (2016) A concise review of updated guidelines regarding the management of hepatocellular carcinoma around the world: 2010–2016. Clin Mol Hepatol 22:7–17

    Article  Google Scholar 

  22. Llovet JM, Bru C, Bruix J (1999) Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 19:329–338

    Article  CAS  Google Scholar 

  23. Kim Y, Ejaz A, Spolverato G et al (2015) Conditional survival after surgical resection of gastric cancer: a multi-institutional analysis of the us gastric cancer collaborative. Ann Surg Oncol 22:557–564

    Article  Google Scholar 

  24. Henson DE, Ries LA (1994) On the estimation of survival. Semin Surg Oncol 10:2–6

    Article  CAS  Google Scholar 

  25. Zabor EC, Gonen M, Chapman PB et al (2013) Dynamic prognostication using conditional survival estimates. Cancer 119:3589–3592

    Article  Google Scholar 

  26. Tsilimigras DI, Mehta R, Paredes AZ et al (2020) overall tumor burden dictates outcomes for patients undergoing resection of multinodular hepatocellular carcinoma beyond the milan criteria. Ann Surg 272:574–581

    Article  Google Scholar 

  27. Cillo U, Vitale A, Grigoletto F et al (2006) Prospective validation of the barcelona clinic liver cancer staging system. J Hepatol 44:723–731

    Article  Google Scholar 

  28. Zamboni BA, Yothers G, Choi M et al (2010) Conditional survival and the choice of conditioning set for patients with colon cancer: an analysis of NSABP trials C-03 through C-07. J Clin Oncol 28:2544–2548

    Article  Google Scholar 

  29. Mayo SC, Nathan H, Cameron JL et al (2012) Conditional survival in patients with pancreatic ductal adenocarcinoma resected with curative intent. Cancer 118:2674–2681

    Article  Google Scholar 

  30. Akateh C, Black SM, Conteh L et al (2019) Neoadjuvant and adjuvant treatment strategies for hepatocellular carcinoma. World J Gastroenterol 25:3704–3721

    Article  Google Scholar 

  31. Wang J, He XD, Yao N et al (2013) A meta-analysis of adjuvant therapy after potentially curative treatment for hepatocellular carcinoma. Can J Gastroenterol 27:351–363

    Article  CAS  Google Scholar 

  32. Yamamoto M, Arii S, Sugahara K et al (1996) Adjuvant oral chemotherapy to prevent recurrence after curative resection for hepatocellular carcinoma. Br J Surg 83:336–340

    Article  CAS  Google Scholar 

  33. Takayama T, Sekine T, Makuuchi M et al (2000) Adoptive immunotherapy to lower postsurgical recurrence rates of hepatocellular carcinoma: a randomised trial. Lancet 356:802–807

    Article  CAS  Google Scholar 

  34. Liao M, Zhu Z, Wang H et al (2017) Adjuvant transarterial chemoembolization for patients after curative resection of hepatocellular carcinoma: a meta-analysis. Scand J Gastroenterol 52:624–634

    Article  Google Scholar 

  35. Qi X, Liu L, Wang D et al (2015) Hepatic resection alone versus in combination with pre- and post-operative transarterial chemoembolization for the treatment of hepatocellular carcinoma: a systematic review and meta-analysis. Oncotarget 6:36838–36859

    Article  Google Scholar 

  36. Cucchetti A, Piscaglia F, Caturelli E et al (2009) Comparison of recurrence of hepatocellular carcinoma after resection in patients with cirrhosis to its occurrence in a surveilled cirrhotic population. Ann Surg Oncol 16:413–422

    Article  Google Scholar 

Download references

Funding

None

Author information

Author notes

  1. Ahmed N. Elfadaly and Diamantis I. Tsilimigras have contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Ahmed N. Elfadaly, Diamantis I. Tsilimigras, J. Madison Hyer, Alessandro Paro, Fabio Bagante & Timothy M. Pawlik

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

    Fabio Bagante & Alfredo Guglielmi

  3. Department of Surgery, Ospedale San Raffaele, Milano, Italy

    Francesca Ratti & Luca Aldrighetti

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

    Hugo P. Marques

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

    Olivier Soubrane

  6. Department of Surgery, Westmead Hospital, Sydney, 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, Canada

    Guillaume Martel & Aklile Workneh

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

    Tom Hugh

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

    Itaru Endo

Authors
  1. Ahmed N. Elfadaly
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Diamantis I. Tsilimigras
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Madison Hyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alessandro Paro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fabio Bagante
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Francesca Ratti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hugo P. Marques
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Olivier Soubrane
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Vincent Lam
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. George A. Poultsides
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Irinel Popescu
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Sorin Alexandrescu
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Guillaume Martel
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Aklile Workneh
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Alfredo Guglielmi
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Tom Hugh
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Luca Aldrighetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Itaru Endo
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Timothy M. Pawlik
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Timothy M. Pawlik.

Ethics declarations

Conflict of interest

None

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Elfadaly, A.N., Tsilimigras, D.I., Hyer, J.M. et al. Impact of Tumor Burden Score on Conditional Survival after Curative-Intent Resection for Hepatocellular Carcinoma: A Multi-Institutional Analysis. World J Surg 45, 3438–3448 (2021). https://doi.org/10.1007/s00268-021-06265-3

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-021-06265-3

Search

Navigation