TY - JOUR
T1 - Development and validation of an α-fetoprotein tumor burden score model to predict postrecurrence survival among patients with hepatocellular carcinoma
AU - Ding, Hong Fan
AU - Yang, Tian
AU - Lv, Yi
AU - Zhang, Xu Feng
AU - Pawlik, Timothy M.
AU - International Hepatocellular Carcinoma Study Group
AU - Ratti, Francesca
AU - Marques, Hugo P.
AU - Silva, Silvia
AU - Soubrane, Olivier
AU - Lam, Vincent
AU - Poultsides, George A.
AU - Popescu, Irinel
AU - Grigorie, Razvan
AU - Alexandrescu, Sorin
AU - Martel, Guillaume
AU - Guglielmi, Alfredo
AU - Hugh, Tom
AU - Aldrighetti, Luca
AU - Endo, Itaru
PY - 2023/5/1
Y1 - 2023/5/1
N2 - BACKGROUND: The purpose of this study is to establish a prognostic model to predict postrecurrence survival (PRS) probability after initial resection of hepatocellular carcinoma (HCC). STUDY DESIGN: Patients with recurrent HCC after curative resection were identified through a multicenter consortium (training cohort, TC); data were from a separate institution were used as validation cohort (VC). The α-fetoprotein (AFP) tumor burden score (ATS) was defined as the distance from the origin on a 3-dimensional Cartesian coordinate system that incorporated 3 variables: largest tumor diameter (x axis), number of tumors (y axis), and ln AFP (z axis). ATS was calculated using the Pythagorean theorem: ATS2 = (largest tumor diameter)2 + (number of tumors)2 + (ln AFP)2, where ATSd and ATSr represent ATS at the time of initial diagnosis and at the time of recurrence, respectively. The final model was ATSm = ATSd + 4 × ATSr. Predictive performance and discrimination of the ATS model were evaluated and compared with traditional staging systems. RESULTS: The ATS model demonstrated strong predictive performance of PRS in both the TC (area under the curve [AUC] 0.70) and VC (AUC 0.71). An ATS-based nomogram was able to stratify patients accurately into low- and high-risk categories relative to PRS (TC: ATSm ≤ 27, 74.9 months vs. ATSm ≥ 28, 23.3 months; VC: ATSm ≤ 27, 59.4 months vs. ATSm ≥ 28, 15.1 months; both p < 0.001). The ATS model predicted PRS among patients undergoing curative or noncurative treatment of HCC recurrence (both p < 0.05). Of note, the ATS model outperformed the Barcelona Clinic Liver Cancer (BCLC), China Liver Cancer (CNLC), and American Joint Committee on Cancer (AJCC) staging systems relative to 1-, 2-, 3-, 4- and 5-year PRS (AUC 0.70, vs. BCLC, AUC 0.50, vs. CNLC, AUC 0.54, vs. AJCC, AUC 0.51). CONCLUSIONS: The ATS model had excellent prognostic discriminatory power to stratify patients relative to PRS.
AB - BACKGROUND: The purpose of this study is to establish a prognostic model to predict postrecurrence survival (PRS) probability after initial resection of hepatocellular carcinoma (HCC). STUDY DESIGN: Patients with recurrent HCC after curative resection were identified through a multicenter consortium (training cohort, TC); data were from a separate institution were used as validation cohort (VC). The α-fetoprotein (AFP) tumor burden score (ATS) was defined as the distance from the origin on a 3-dimensional Cartesian coordinate system that incorporated 3 variables: largest tumor diameter (x axis), number of tumors (y axis), and ln AFP (z axis). ATS was calculated using the Pythagorean theorem: ATS2 = (largest tumor diameter)2 + (number of tumors)2 + (ln AFP)2, where ATSd and ATSr represent ATS at the time of initial diagnosis and at the time of recurrence, respectively. The final model was ATSm = ATSd + 4 × ATSr. Predictive performance and discrimination of the ATS model were evaluated and compared with traditional staging systems. RESULTS: The ATS model demonstrated strong predictive performance of PRS in both the TC (area under the curve [AUC] 0.70) and VC (AUC 0.71). An ATS-based nomogram was able to stratify patients accurately into low- and high-risk categories relative to PRS (TC: ATSm ≤ 27, 74.9 months vs. ATSm ≥ 28, 23.3 months; VC: ATSm ≤ 27, 59.4 months vs. ATSm ≥ 28, 15.1 months; both p < 0.001). The ATS model predicted PRS among patients undergoing curative or noncurative treatment of HCC recurrence (both p < 0.05). Of note, the ATS model outperformed the Barcelona Clinic Liver Cancer (BCLC), China Liver Cancer (CNLC), and American Joint Committee on Cancer (AJCC) staging systems relative to 1-, 2-, 3-, 4- and 5-year PRS (AUC 0.70, vs. BCLC, AUC 0.50, vs. CNLC, AUC 0.54, vs. AJCC, AUC 0.51). CONCLUSIONS: The ATS model had excellent prognostic discriminatory power to stratify patients relative to PRS.
UR - http://www.scopus.com/inward/record.url?scp=85152624405&partnerID=8YFLogxK
U2 - 10.1097/XCS.0000000000000638
DO - 10.1097/XCS.0000000000000638
M3 - Article
C2 - 36744779
AN - SCOPUS:85152624405
SN - 1072-7515
VL - 236
SP - 982
EP - 992
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 5
ER -