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23.02.2023 | Hepatobiliary Tumors

TBS-Based Preoperative Score to Predict Non-transplantable Recurrence and Identify Candidates for Upfront Resection Versus Transplantation for Hepatocellular Carcinoma

verfasst von: Henrique A. Lima, MD, Zorays Moazzam, MD, Yutaka Endo, MD, PhD, Laura Alaimo, MD, Chanza Shaikh, MD, Muhammad Musaab Munir, MD, Vivian Resende, MD, PhD, Alfredo Guglielmi, MD, Hugo P. Marques, MD, François Cauchy, MD, Vincent Lam, MD, George A. Poultsides, MD, Irinel Popescu, MD, Sorin Alexandrescu, MD, Guillaume Martel, MD, Tom Hugh, MD, Itaru Endo, MD, Minoru Kitago, MD, Feng Shen, MD, Timothy M. Pawlik, MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.)

Erschienen in: Annals of Surgical Oncology | Ausgabe 6/2023

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Abstract

Background

Recurrence following liver resection (LR) for hepatocellular carcinoma (HCC) can be as high as 50–70%. While salvage liver transplantation may be feasible, patients may develop a non-transplantable recurrence (NTR) (recurrence beyond Milan criteria). We sought to identify preoperative risk factors to predict NTR after resection.

Patients and Methods

Patients who underwent curative-intent LR for HCC were identified from a multi-institutional database. Preoperative factors associated with NTR were identified and a risk score model (NTR score) was developed and validated.

Results

Among 1620 patients, 842 (52.0%) developed recurrence; among patients with recurrence, NTR occurred in 341 (40.5%) with a median recurrence-free survival (RFS) of 30 months (24.7–35.3 months). On multivariable analysis, factors associated with NTR included alpha fetoprotein (AFP) > 400 ng/mL [hazard ratio (HR) 1.71, 95% confidence interval (CI) 1.33–2.19], albumin–bilirubin grade (ALBI) (referent low, medium ALBI: HR 1.41, 95% CI 1.10–1.81, high ALBI: HR 2.47, 95% CI 0.91–6.68), and tumor burden score (TBS) (referent low, high TBS: HR 2.55, 95% CI, 1.99–3.28). A simplified TBS-based NTR score was developed using the β-coefficients of each factor (C-index 0.68, 95% CI 0.65–0.71). Higher NTR score was associated with incrementally worse 5-year RFS (low 44.8%, medium 37.5%, high 24.5%) [area under the curve (AUC) 0.59] and increased incidence of NTR (low 13.7%, medium 25.4%, high 38.2%) (AUC 0.65) (both p < 0.001). Moreover, higher NTR score was associated with higher risk of extrahepatic recurrence (low 11.3%, medium 28.8%, high 37.5%) (p < 0.001).

Conclusion

NTR following curative-intent resection of HCC occurred in one in five patients. A simple TBS-based NTR score accurately predicted the risk of NTR and may help identify candidates for upfront resection versus transplantation.

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Titel: TBS-Based Preoperative Score to Predict Non-transplantable Recurrence and Identify Candidates for Upfront Resection Versus Transplantation for Hepatocellular Carcinoma
verfasst von: Henrique A. Lima, MD
Zorays Moazzam, MD
Yutaka Endo, MD, PhD
Laura Alaimo, MD
Chanza Shaikh, MD
Muhammad Musaab Munir, MD
Vivian Resende, MD, PhD
Alfredo Guglielmi, MD
Hugo P. Marques, MD
François Cauchy, MD
Vincent Lam, MD
George A. Poultsides, MD
Irinel Popescu, MD
Sorin Alexandrescu, MD
Guillaume Martel, MD
Tom Hugh, MD
Itaru Endo, MD
Minoru Kitago, MD
Feng Shen, MD
Timothy M. Pawlik, MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.)
Publikationsdatum: 23.02.2023
Verlag: Springer International Publishing
Erschienen in: Annals of Surgical Oncology / Ausgabe 6/2023
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-023-13273-1

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TBS-Based Preoperative Score to Predict Non-transplantable Recurrence and Identify Candidates for Upfront Resection Versus Transplantation for Hepatocellular Carcinoma