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A Novel Score Predicts HBV-Related Hepatocellular Carcinoma Recurrence After Hepatectomy: a Retrospective Multicenter Study

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

In China, hepatitis B virus (HBV) is an important causative factor of hepatocellular carcinoma (HCC). The contribution and interaction of fibrosis-4 (FIB-4) score and total tumor volume (TTV) in association with HCC recurrence is unknown. A reliable point score based on the FIB-4 score, TTV, and differentiation grade was established to predict the postoperative recurrence of HBV-related HCC patients who underwent hepatic resection (HR).

Methods

Three hundred thirty-eight HBV-related HCC patients from three institutions treated by HR were enrolled in this retrospective study. Prognostic factors were also evaluated by univariate and multivariate analysis using Cox’s proportional hazards model in the training cohort. The DFT score was established by a Cox regression model and validated in the internal cohort and the external cohorts from the other two institutions.

Results

The DFT score differentiated four groups of HBV-related HCC patients (0, 1–2, 3, 4–5 points) with distinct prognosis (median recurrence-free survival (RFS), 72.7 vs. 53.0 vs. 23.2 vs. 5.7 months; P < 0.05). Its predictive accuracy as determined by the area under the receiver operating characteristic curve (AUC) at 1, 3, and 5 years (AUCs 0.7319, 0.7031, and 0.6972) was greater than the other three staging systems for HCC. These findings were supported by the validation cohorts.

Conclusions

The DFT model is a reliable and objective model to predict the RFS of HBV-related HCC patients after HR.

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References

  1. Makuuchi M, Takayama T, Kubota K, Kimura W, Midorikawa Y, Miyagawa S, Kawasaki S. Hepatic resection for hepatocellular carcinoma—Japanese experience. Hepatogastroenterology. 1998; 45(Suppl 3): 1267–1274.

    PubMed  Google Scholar 

  2. Poon RT, Fan ST. Evaluation of the new AJCC/UICC staging system for hepatocellular carcinoma after hepatic resection in Chinese patients. Surg Oncol Clin North Am. 2003; 12(1): 35–50.

    Article  Google Scholar 

  3. Bruix J, Sherman M, Practice Guidelines Committee American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology. 2005; 42(5): 1208–1236.

    Article  PubMed  Google Scholar 

  4. European Association For The Study Of The Liver and European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012; 56(4): 908–943.

    Article  Google Scholar 

  5. Zhong JH, Ke Y, Gong WF, Xiang BD, Ma L, Ye XP, Peng T, Xie GS, Li LQ. Hepatic resection associated with good survival for selected patients with intermediate and advanced-stage hepatocellular carcinoma. Ann Surg. 2014; 260(2): 329–340.

    Article  PubMed  Google Scholar 

  6. Sherman M: Recurrence of hepatocellular carcinoma. N Engl J Med. 2008; 359(19): 2045–2047.

    Article  CAS  PubMed  Google Scholar 

  7. Bruix J, Gores GJ, Mazzaferro V. Hepatocellular carcinoma: clinical frontiers and perspectives. Gut. 2014; 63(5): 844–855.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Kim WR, Berg T, Asselah T, Flisiak R, Fung S, Gordon SC, Janssen HL, Lampertico P, Lau D, Bornstein JD, Schall RE, Dinh P, Yee LJ, Martins EB, Lim SG, Loomba R, Petersen J, Buti M, Marcellin P. Evaluation of APRI and FIB-4 scoring systems for non-invasive assessment of hepatic fibrosis in chronic hepatitis B patients. J Hepatol. 2016; 64(4): 773–780.

    Article  CAS  PubMed  Google Scholar 

  9. Toyoda H, Kumada T, Tada T, Kaneoka Y, Maeda A. A laboratory marker, FIB-4 index, as a predictor for long-term outcomes of hepatocellular carcinoma patients after curative hepatic resection. Surgery. 2015; 157(4): 699–707.

    Article  PubMed  Google Scholar 

  10. Liao R, Li DW, Du CY, Li M. Combined Preoperative ALBI and FIB-4 Is Associated with Recurrence of Hepatocellular Carcinoma After Curative Hepatectomy. J Gastrointest Surg. 2018; 22 (10):1679–1687.

    Article  PubMed  Google Scholar 

  11. Hsu CY, Huang YH, Hsia CY, Su CW, Lin HC, Loong CC, Chiou YY, Chiang JH, Lee PC, Huo TI, Lee SD. A new prognostic model for hepatocellular carcinoma based on total tumor volume: the Taipei Integrated Scoring System. J Hepatol. 2010; 53(1): 108–117.

    Article  PubMed  Google Scholar 

  12. Toso C, Asthana S, Bigam DL, Shapiro AM, Kneteman NM. Reassessing selection criteria prior to liver transplantation for hepatocellular carcinoma utilizing the Scientific Registry of Transplant Recipients database. Hepatology. 2009; 49(3): 832–838.

    Article  PubMed  Google Scholar 

  13. Lee YH, Hsu CY, Huang YH, Su CW, Lin HC, Hsia CY, Huo TI. α-fetoprotein-to-total tumor volume ratio predicts post-operative tumor recurrence in hepatocellular carcinoma. J Gastrointest Surg. 2013; 17(4): 730–738.

    Article  PubMed  Google Scholar 

  14. Wei Q, Tian H, Luo HX, Zhang YC, Deng YN, Yao J, Li H, Chen GH, Yang Y. Better prognosis of hepatic resection combined with antiviral therapy for HBV-related hepatocellular carcinoma with BCLC Stage B/C. Asian J Surg. 2017; 40(6): 453–462.

    Article  PubMed  Google Scholar 

  15. Yang LY, Fang F, Ou DP, Wu W, Zeng ZJ, Wu F. Solitary large hepatocellular carcinoma: a specific subtype of hepatocellular carcinoma with good outcome after hepatic resection. Ann Surg. 2009; 249(1): 118–23.

    Article  PubMed  Google Scholar 

  16. He W, Zeng Q, Zheng Y, Chen M, Shen J, Qiu J, Chen M, Zou R, Liao Y, Li Q, Wu X, Li B, Yuan Y. The role of clinically significant portal hypertension in hepatic resection for hepatocellular carcinoma patients: a propensity score matching analysis. BMC Cancer. 2015;15: 263.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Imamura H, Matsuyama Y, Tanaka E, Ohkubo T, Hasegawa K, Miyagawa S, Sugawara Y, Minagawa M, Takayama T, Kawasaki S, Makuuchi M. Risk factors contributing to early and late phase intrahepatic recurrence of hepatocellular carcinoma after hepatectomy. J Hepatol. 2003; 38(2): 200–207.

    Article  PubMed  Google Scholar 

  18. Wu JC, Huang YH, Chau GY, Su CW, Lai CR, Lee PC, Huo TI, Sheen IJ, Lee SD, Lui WY. Risk factors for early and late recurrence in hepatitis B-related hepatocellular carcinoma. J Hepatol. 2009; 51(5): 890–897.

    Article  PubMed  Google Scholar 

  19. Shah SA, Cleary SP, Wei AC, Yang I, Taylor BR, Hemming AW, Langer B, Grant DR, Greig PD, Gallinger S. Recurrence after liver resection for hepatocellular carcinoma: risk factors, treatment, and outcomes. Surgery. 2007; 141(3): 330–339.

    Article  PubMed  Google Scholar 

  20. Andreou A, Vauthey JN, Cherqui D, Zimmitti G, Ribero D, Truty MJ, Wei SH, Curley SA, Laurent A, Poon RT, Belghiti J, Nagorney DM, Aloia TA. International Cooperative Study Group on Hepatocellular Carcinoma. Improved long-term survival after major resection for hepatocellular carcinoma: a multicenter analysis based on a new definition of major hepatectomy. J Gastrointest Surg. 2013; 17(1): 66–77.

    Article  PubMed  Google Scholar 

  21. Cucchetti A, Piscaglia F, Caturelli E, Benvegnù L, Vivarelli M, Ercolani G, Cescon M, Ravaioli M, Grazi GL, Bolond L, Pinna AD. Comparison of recurrence of hepatocellular carcinoma after resection in patients with cirrhosis to its occurrence in a surveilled cirrhotic population. Ann Surg Oncol. 2009; 16(2): 413–422.

    Article  PubMed  Google Scholar 

  22. Truty MJ, Vauthey JN. Surgical resection of high-risk hepatocellular carcinoma: patient selection, preoperative considerations, and operative technique. Ann Surg Oncol. 2010; 17(5): 1219–1225.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Hosaka T, Ikeda K, Kobayashi M, Hirakawa M, Kawamura Y, Yatsuji H, Sezaki H, Akuta N, Suzuki F, Suzuki Y, Saitoh S, Arase Y, Kumada H. Predictive factors of advanced recurrence after curative resection of small hepatocellular carcinoma. Liver Int. 2009; 29(5): 736–742.

    Article  PubMed  Google Scholar 

  24. Okamura Y, Ashida R, Yamamoto Y, Ito T, Sugiura T, Uesaka K. FIB-4 Index is a Predictor of Background Liver Fibrosis and Long-Term Outcomes After Curative Resection of Hepatocellular Carcinoma. Ann Surg Oncol. 2016; 23(Suppl 4): 467–474.

    Article  PubMed  Google Scholar 

Download references

Financial Support

This work was supported by the grants from the Project funded by China Postdoctoral Science Foundation (2017M611459), National Natural Science Foundation of China (No. 81370575, 81570593), Sci-tech Research Development Program of Guangzhou city (No. 1581000156, 201400000001-3), and Sun Yat-sen University Clinical Research 5010 Program (2014006).

Author information

Author notes

  1. Wei Qin, Li Wang, Beiyuan Hu, Shusheng Leng and Huan Tian contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, Huashan Hospital, Cancer Metastasis Institute, Fudan University, Shanghai, 200040, China

    Wei Qin, Beiyuan Hu & Chao Wu

  2. Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China

    Wei Qin, Li Wang, Huanxian Luo, Jia Yao, Xiaolong Chen, Guihua Chen & Yang Yang

  3. Department of General Surgery, The Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, 610081, China

    Shusheng Leng

  4. Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China

    Huan Tian

  5. Guangdong Provincial Key Laboratory of Liver Disease Research, Guangzhou, 510630, China

    Guihua Chen & Yang Yang

Authors
  1. Wei Qin
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  2. Li Wang
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  3. Beiyuan Hu
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  4. Shusheng Leng
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  8. Xiaolong Chen
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  9. Chao Wu
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  10. Guihua Chen
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  11. Yang Yang
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Contributions

Conception and design: Wei Qin, Guihua Chen, Yang Yang

Acquisition of data: Li Wang, Beiyuan Hu, Shusheng Leng, Huanxian Luo

Analysis and interpretation of data: Huan Tian, Jia Yao, Chao Wu

Writing, review, and/or revision of the manuscript: Wei Qin, Xiaolong Chen, Yang Yang

Corresponding authors

Correspondence to Wei Qin, Guihua Chen or Yang Yang.

Ethics declarations

This study was approved by the Ethics Committee of The Third Affiliated Hospital of Sun Yat-Sen University, Huashan Hospital, Fudan University, The Affiliated Hospital/Clinical Medical College of Chengdu University, and conducted in accordance with the Declaration of Helsinki. A written informed consent was obtained from all the patients at the time of admission.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Qin, W., Wang, L., Hu, B. et al. A Novel Score Predicts HBV-Related Hepatocellular Carcinoma Recurrence After Hepatectomy: a Retrospective Multicenter Study. J Gastrointest Surg 23, 922–932 (2019). https://doi.org/10.1007/s11605-018-4037-x

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  • DOI: https://doi.org/10.1007/s11605-018-4037-x

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