Preoperative risk score (PreopScore) to predict overall survival after resection for hepatocellular carcinoma

Yutaka Endo; Henrique A. Lima; Laura Alaimo; Zorays Moazzam; Zachary Brown; Chanza F. Shaikh; Francesca Ratti; Hugo P. Marques; Olivier Soubrane; Vincent Lam; George A. Poultsides; Irinel Popescu; Sorin Alexandrescu; Guillaume Martel; Aklile Workneh; Alfredo Guglielmi; Tom Hugh; Luca Aldrighetti; Feng Shen; Itaru Endo; Timothy M. Pawlik

doi:10.1016/j.hpb.2022.12.009

Preoperative risk score (PreopScore) to predict overall survival after resection for hepatocellular carcinoma

Yutaka Endo, Henrique A. Lima, Laura Alaimo, Zorays Moazzam, Zachary Brown, Chanza F. Shaikh, Francesca Ratti, Hugo P. Marques, Olivier Soubrane, Vincent Lam, George A. Poultsides, Irinel Popescu, Sorin Alexandrescu, Guillaume Martel, Aklile Workneh, Alfredo Guglielmi, Tom Hugh, Luca Aldrighetti, Feng Shen, Itaru EndoTimothy M. Pawlik^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

20 Citations (Scopus)

Abstract

Background: This study aimed to develop a holistic risk score incorporating preoperative tumor, liver, nutritional, and inflammatory markers to predict overall survival (OS) after hepatectomy for hepatocellular carcinoma (HCC). Methods: Patients who underwent curative-intent surgery for HCC between 2000 and 2020 were identified using an international multi-institutional database. Preoperative predictors associated with OS were selected and a prognostic risk score model (PreopScore) was developed and validated using cross-validation. Results: A total of 1676 patients were included. On multivariable analysis, preoperative parameters associated with OS included α-feto protein (hazard ratio [HR]1.17, 95%CI 1.03–1.34), neutrophil-to-lymphocyte ratio (HR2.62, 95%CI 1.30–5.30), albumin (HR0.49, 95%CI 0.34–0.70), gamma-glutamyl transpeptidase (HR1.00, 95%CI 1.00–1.00), as well as vascular involvement (HR3.52, 95%CI 2.10–5.89) and tumor burden score (medium, HR3.49, 95%CI 1.62–7.58; high, HR3.21, 95%CI 1.40–7.35) on preoperative imaging. A weighted PreopScore was devised and made available online (https://yutaka-endo.shinyapps.io/PrepoScore_Shiny/). Patients with a PreopScore 0–2, 2–3.5, and >3.5 had incrementally worse 5-year OS of 85.8%, 70.7%, and 52.4%, respectively (p < 0.001). The c-index of the test and validation cohort were 0.75 and 0.71, respectively. The PreopScore outperformed individual parameters and previous HCC staging systems. Discussion: The PreopScore can be used as a better guide to preoperatively identify patients and individualize pre-/post-operative strategies.

Original language	English
Pages (from-to)	353-362
Number of pages	10
Journal	HPB
Volume	25
Issue number	3
DOIs	https://doi.org/10.1016/j.hpb.2022.12.009
Publication status	Published - Mar 2023
Externally published	Yes

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10.1016/j.hpb.2022.12.009

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Endo, Y., Lima, H. A., Alaimo, L., Moazzam, Z., Brown, Z., Shaikh, C. F., Ratti, F., Marques, H. P., Soubrane, O., Lam, V., Poultsides, G. A., Popescu, I., Alexandrescu, S., Martel, G., Workneh, A., Guglielmi, A., Hugh, T., Aldrighetti, L., Shen, F., ... Pawlik, T. M. (2023). Preoperative risk score (PreopScore) to predict overall survival after resection for hepatocellular carcinoma. HPB, 25(3), 353-362. https://doi.org/10.1016/j.hpb.2022.12.009

@article{0ffc3de28df24d01b3d95d15ba12b056,

title = "Preoperative risk score (PreopScore) to predict overall survival after resection for hepatocellular carcinoma",

abstract = "Background: This study aimed to develop a holistic risk score incorporating preoperative tumor, liver, nutritional, and inflammatory markers to predict overall survival (OS) after hepatectomy for hepatocellular carcinoma (HCC). Methods: Patients who underwent curative-intent surgery for HCC between 2000 and 2020 were identified using an international multi-institutional database. Preoperative predictors associated with OS were selected and a prognostic risk score model (PreopScore) was developed and validated using cross-validation. Results: A total of 1676 patients were included. On multivariable analysis, preoperative parameters associated with OS included α-feto protein (hazard ratio [HR]1.17, 95\%CI 1.03–1.34), neutrophil-to-lymphocyte ratio (HR2.62, 95\%CI 1.30–5.30), albumin (HR0.49, 95\%CI 0.34–0.70), gamma-glutamyl transpeptidase (HR1.00, 95\%CI 1.00–1.00), as well as vascular involvement (HR3.52, 95\%CI 2.10–5.89) and tumor burden score (medium, HR3.49, 95\%CI 1.62–7.58; high, HR3.21, 95\%CI 1.40–7.35) on preoperative imaging. A weighted PreopScore was devised and made available online (https://yutaka-endo.shinyapps.io/PrepoScore\_Shiny/). Patients with a PreopScore 0–2, 2–3.5, and >3.5 had incrementally worse 5-year OS of 85.8\%, 70.7\%, and 52.4\%, respectively (p < 0.001). The c-index of the test and validation cohort were 0.75 and 0.71, respectively. The PreopScore outperformed individual parameters and previous HCC staging systems. Discussion: The PreopScore can be used as a better guide to preoperatively identify patients and individualize pre-/post-operative strategies.",

author = "Yutaka Endo and Lima, \{Henrique A.\} and Laura Alaimo and Zorays Moazzam and Zachary Brown and Shaikh, \{Chanza F.\} and Francesca Ratti and Marques, \{Hugo P.\} and Olivier Soubrane and Vincent Lam and Poultsides, \{George A.\} and Irinel Popescu and Sorin Alexandrescu and Guillaume Martel and Aklile Workneh and Alfredo Guglielmi and Tom Hugh and Luca Aldrighetti and Feng Shen and Itaru Endo and Pawlik, \{Timothy M.\}",

year = "2023",

month = mar,

doi = "10.1016/j.hpb.2022.12.009",

language = "English",

volume = "25",

pages = "353--362",

journal = "HPB",

issn = "1365-182X",

publisher = "Elsevier",

number = "3",

}

Endo, Y, Lima, HA, Alaimo, L, Moazzam, Z, Brown, Z, Shaikh, CF, Ratti, F, Marques, HP, Soubrane, O, Lam, V, Poultsides, GA, Popescu, I, Alexandrescu, S, Martel, G, Workneh, A, Guglielmi, A, Hugh, T, Aldrighetti, L, Shen, F, Endo, I & Pawlik, TM 2023, 'Preoperative risk score (PreopScore) to predict overall survival after resection for hepatocellular carcinoma', HPB, vol. 25, no. 3, pp. 353-362. https://doi.org/10.1016/j.hpb.2022.12.009

TY - JOUR

T1 - Preoperative risk score (PreopScore) to predict overall survival after resection for hepatocellular carcinoma

AU - Endo, Yutaka

AU - Lima, Henrique A.

AU - Alaimo, Laura

AU - Moazzam, Zorays

AU - Brown, Zachary

AU - Shaikh, Chanza F.

AU - Ratti, Francesca

AU - Marques, Hugo P.

AU - Soubrane, Olivier

AU - Lam, Vincent

AU - Poultsides, George A.

AU - Popescu, Irinel

AU - Alexandrescu, Sorin

AU - Martel, Guillaume

AU - Workneh, Aklile

AU - Guglielmi, Alfredo

AU - Hugh, Tom

AU - Aldrighetti, Luca

AU - Shen, Feng

AU - Endo, Itaru

AU - Pawlik, Timothy M.

PY - 2023/3

Y1 - 2023/3

N2 - Background: This study aimed to develop a holistic risk score incorporating preoperative tumor, liver, nutritional, and inflammatory markers to predict overall survival (OS) after hepatectomy for hepatocellular carcinoma (HCC). Methods: Patients who underwent curative-intent surgery for HCC between 2000 and 2020 were identified using an international multi-institutional database. Preoperative predictors associated with OS were selected and a prognostic risk score model (PreopScore) was developed and validated using cross-validation. Results: A total of 1676 patients were included. On multivariable analysis, preoperative parameters associated with OS included α-feto protein (hazard ratio [HR]1.17, 95%CI 1.03–1.34), neutrophil-to-lymphocyte ratio (HR2.62, 95%CI 1.30–5.30), albumin (HR0.49, 95%CI 0.34–0.70), gamma-glutamyl transpeptidase (HR1.00, 95%CI 1.00–1.00), as well as vascular involvement (HR3.52, 95%CI 2.10–5.89) and tumor burden score (medium, HR3.49, 95%CI 1.62–7.58; high, HR3.21, 95%CI 1.40–7.35) on preoperative imaging. A weighted PreopScore was devised and made available online (https://yutaka-endo.shinyapps.io/PrepoScore_Shiny/). Patients with a PreopScore 0–2, 2–3.5, and >3.5 had incrementally worse 5-year OS of 85.8%, 70.7%, and 52.4%, respectively (p < 0.001). The c-index of the test and validation cohort were 0.75 and 0.71, respectively. The PreopScore outperformed individual parameters and previous HCC staging systems. Discussion: The PreopScore can be used as a better guide to preoperatively identify patients and individualize pre-/post-operative strategies.

AB - Background: This study aimed to develop a holistic risk score incorporating preoperative tumor, liver, nutritional, and inflammatory markers to predict overall survival (OS) after hepatectomy for hepatocellular carcinoma (HCC). Methods: Patients who underwent curative-intent surgery for HCC between 2000 and 2020 were identified using an international multi-institutional database. Preoperative predictors associated with OS were selected and a prognostic risk score model (PreopScore) was developed and validated using cross-validation. Results: A total of 1676 patients were included. On multivariable analysis, preoperative parameters associated with OS included α-feto protein (hazard ratio [HR]1.17, 95%CI 1.03–1.34), neutrophil-to-lymphocyte ratio (HR2.62, 95%CI 1.30–5.30), albumin (HR0.49, 95%CI 0.34–0.70), gamma-glutamyl transpeptidase (HR1.00, 95%CI 1.00–1.00), as well as vascular involvement (HR3.52, 95%CI 2.10–5.89) and tumor burden score (medium, HR3.49, 95%CI 1.62–7.58; high, HR3.21, 95%CI 1.40–7.35) on preoperative imaging. A weighted PreopScore was devised and made available online (https://yutaka-endo.shinyapps.io/PrepoScore_Shiny/). Patients with a PreopScore 0–2, 2–3.5, and >3.5 had incrementally worse 5-year OS of 85.8%, 70.7%, and 52.4%, respectively (p < 0.001). The c-index of the test and validation cohort were 0.75 and 0.71, respectively. The PreopScore outperformed individual parameters and previous HCC staging systems. Discussion: The PreopScore can be used as a better guide to preoperatively identify patients and individualize pre-/post-operative strategies.

UR - https://www.scopus.com/pages/publications/85149101201

U2 - 10.1016/j.hpb.2022.12.009

DO - 10.1016/j.hpb.2022.12.009

M3 - Article

C2 - 36670007

AN - SCOPUS:85149101201

SN - 1365-182X

VL - 25

SP - 353

EP - 362

JO - HPB

JF - HPB

IS - 3

ER -

Preoperative risk score (PreopScore) to predict overall survival after resection for hepatocellular carcinoma

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