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Radiographic tumor burden score is useful for stratifying the overall survival of hepatocellular carcinoma patients undergoing resection at different Barcelona Clinic Liver Cancer stages

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Abstract

Purpose

The Barcelona Clinic Liver Cancer (BCLC) staging system has been recommended for prognostic prediction. However, prognosis is variable at different BCLC stages. We aimed to evaluate whether the radiographic tumor burden score (TBS) could be used to stratify prognosis in different BCLC stages.

Methods

Hepatocellular carcinoma (HCC) patients undergoing liver resection (LR) at BCLC-0, -A, or -B stage in our institution in 2007–2018 were divided into derivation and validation cohorts. Overall survival (OS) was analyzed according to the TBS and BCLC stage. TBS cutoff values for OS were determined with X-tile.

Results

Of the 749 patients in the derivation cohort, 138 (18.4%) had BCLC-0, 542 (72.3%) BCLC-A, and 69 (9.2%) BCLC-B HCC; 76 (10.1%) had a high TBS (> 7.9), 477 (63.7%) a medium TBS (2.6–7.9), and 196 (26.2%) a low TBS (< 2.6). OS worsened progressively with increasing TBS in the cohort (p < 0.001) and in BCLC-A (p = 0.04) and BCLC-B (p = 0.002) stages. Multivariate analysis showed that the TBS was associated with OS of patients with BCLC-A (medium vs. low TBS: hazard ratio [HR] = 2.390, 95% CI = 1.024–5.581, p = 0.04; high vs. low TBS: HR = 3.885, 95% CI = 1.443–10.456, p = 0.007) and BCLC-B (high vs. medium TBS: HR = 2.542, 95% CI = 1.077–6.002, p = 0.033) HCC. The TBS could also be used to stratify the OS of patients in the validation cohort (p < 0.001).

Conclusion

The TBS could be used to stratify the OS of the entire cohort and BCLC stages A and B of HCC patients undergoing LR.

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Acknowledgements

The authors thank Cancer Center, Kaohsiung Chang Gung Memorial Hospital for the provision of HCC registry data. The authors thank Chih-Yun Lin and Nien-Tzu Hsu and the Biostatistics Center, Kaohsiung Chang Gung Memorial Hospital for statistics work.

Funding

This study was supported by Grant CMRPG8L0181 from the Chang Gung Memorial Hospital-Kaohsiung Medical Center, Taiwan.

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Author notes

  1. Chih-Chi Wang and Yi-Hao Yen contributed equally to this work.

Authors and Affiliations

  1. Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta Pei Road, Kaohsiung, Taiwan

    Wei-Feng Li, Yueh-Wei Liu, Chih-Chi Wang, Chee-Chien Yong & Chih-Che Lin

  2. Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Kaohsiung, Taiwan

    Yi-Hao Yen

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Contributions

Conception or design of the work: YHY, CCW. The acquisition, analysis, or interpretation of data: WFL, YWL, CCW, CCY, CCL. Drafted the work: YHY, WFL. Revised it critically for important intellectual content: CCW. Approved the version to be published: all authors. Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: all authors.

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Correspondence to Chih-Chi Wang or Yi-Hao Yen.

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Supplementary Information

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Supplementary Fig. 1

Flow chart of enrollment of the derivation cohort (PDF 77 kb)

Supplementary Fig. 2

Flow chart of enrollment of the validation cohort (PDF 75 kb)

Supplementary Fig. 3

Overall survival rate in the derivation cohort (PNG 45 kb)

High resolution image (TIF 100 kb)

Supplementary Fig. 4

Overall survival rate in the validation cohort (PNG 42 kb)

High resolution image (TIF 102 kb)

Supplementary Fig. 5

Distribution of the tumor burden score among the patients with and without recurrence in the derivation cohort (PNG 92 kb)

High resolution image (TIF 313 kb)

Supplementary Fig. 6

Distribution of the tumor burden score among the patients with and without recurrence in the validation cohort (PNG 62 kb)

High resolution image (TIF 201 kb)

Supplementary Fig. 7

Correlation between the tumor burden score and maximal tumor size in the derivation cohort (PNG 64 kb)

High resolution image (TIF 180 kb)

Supplementary Fig. 8

Correlation between the tumor burden score and maximal tumor size in the validation cohort (PNG 58 kb)

High resolution image (TIF 155 kb)

Supplementary Fig. 9

Distribution of the tumor burden score among the patients with different tumor numbers in the derivation cohort (PNG 81 kb)

High resolution image (TIF 268 kb)

Supplementary Fig. 10

Distribution of the tumor burden score among the patients with different tumor numbers in the validation cohort (PNG 59 kb)

High resolution image (TIF 184 kb)

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Li, WF., Liu, YW., Wang, CC. et al. Radiographic tumor burden score is useful for stratifying the overall survival of hepatocellular carcinoma patients undergoing resection at different Barcelona Clinic Liver Cancer stages. Langenbecks Arch Surg 408, 169 (2023). https://doi.org/10.1007/s00423-023-02869-6

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