TAC score better predicts survival than the BCLC following resection of hepatocellular carcinoma

Henrique A. Lima; Yutaka Endo; Zorays Moazzam; Laura Alaimo; Chanza Shaikh; Muhammad M. Munir; Vivian Resende; Alfredo Guglielmi; Hugo P. Marques; Francois Cauchy; Vincent Lam; George A. Poultsides; Irinel Popescu; Sorin Alexandrescu; Guillaume Martel; Itaru Endo; Minoru Kitago; Feng Shen; Timothy M. Pawlik

doi:10.1002/jso.27116

TAC score better predicts survival than the BCLC following resection of hepatocellular carcinoma

Henrique A. Lima, Yutaka Endo, Zorays Moazzam, Laura Alaimo, Chanza Shaikh, Muhammad M. Munir, Vivian Resende, Alfredo Guglielmi, Hugo P. Marques, Francois Cauchy, Vincent Lam, George A. Poultsides, Irinel Popescu, Sorin Alexandrescu, Guillaume Martel, Itaru Endo, Minoru Kitago, Feng Shen, Timothy M. Pawlik^*

^*Corresponding author for this work

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

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Abstract

Background: Heterogeneity in hepatocellular carcinoma (HCC) still exists within the Barcelona clinic liver cancer (BCLC) subcategories. We developed a simple model to better discriminate and predict prognosis following resection. Methods: Patients who underwent curative-intent resection for HCC were identified from a multi-institutional database. Predictive factors of survival were identified to develop TAC (tumor burden score [TBS], alpha-fetoprotein [AFP], Child−Pugh CP]) score. Results: Among 1435 patients, median TBS was 5.1 (interquartile range [IQR]: 3.2−8.1), median AFP was 18.3 ng/ml (IQR 4.0−362.5), and 1391 (96.9%) patients were classified as CP-A. Factors associated with overall survival (OS) included TBS (low: referent; medium: HR 2.26, 95% CI: 1.73−2.96; high: HR = 3.35, 95% CI: 2.22−5.07), AFP (<400 ng/ml: referent; >400 ng/ml: HR = 1.56, 95% CI: 1.27−1.92), and CP (A: referent; B: HR = 1.81, 95% CI: 1.12−2.92) (all p < 0.05). A simplified risk score demonstrated superior concordance index, Akaike information criteria, homogeneity, and area under the curve versus BCLC (0.620 vs. 0.541; 5484.655 vs. 5536.454; 60.099 vs. 16.194; 0.62 vs. 0.55, respectively), and further stratified patients within BCLC groups relative to OS (BCLC 0, very low: 86.8%, low: 47.8%) (BCLC A, very low: 79.7%, low: 68.1%, medium: 52.5%, high: 35.6%) (BCLC B, low: 59.8%, medium: 43.7%, high: N/A). Conclusion: TAC is a simple, holistic score that consistently outperformed BCLC relative to discrimination power and prognostication following resection of HCC.

Original language	English
Pages (from-to)	374-384
Number of pages	11
Journal	Journal of Surgical Oncology
Volume	127
Issue number	3
Early online date	4 Oct 2022
DOIs	https://doi.org/10.1002/jso.27116
Publication status	Published - Mar 2023
Externally published	Yes

Bibliographical note

Copyright the Author(s) 2022. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

Barcelona clinic liver cancer
hepatocellular carcinoma
multi-institutional database
prognosis
resection
tumor burden score

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10.1002/jso.27116Licence: CC BY-NC-ND

Publisher version (open access)Final published version, 1.31 MBLicence: CC BY-NC-ND

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Lima, H. A., Endo, Y., Moazzam, Z., Alaimo, L., Shaikh, C., Munir, M. M., Resende, V., Guglielmi, A., Marques, H. P., Cauchy, F., Lam, V., Poultsides, G. A., Popescu, I., Alexandrescu, S., Martel, G., Endo, I., Kitago, M., Shen, F., & Pawlik, T. M. (2023). TAC score better predicts survival than the BCLC following resection of hepatocellular carcinoma. Journal of Surgical Oncology, 127(3), 374-384. https://doi.org/10.1002/jso.27116

@article{66ead8096c364e6ca1aacfd9fbeedeb6,

title = "TAC score better predicts survival than the BCLC following resection of hepatocellular carcinoma",

abstract = "Background: Heterogeneity in hepatocellular carcinoma (HCC) still exists within the Barcelona clinic liver cancer (BCLC) subcategories. We developed a simple model to better discriminate and predict prognosis following resection. Methods: Patients who underwent curative-intent resection for HCC were identified from a multi-institutional database. Predictive factors of survival were identified to develop TAC (tumor burden score [TBS], alpha-fetoprotein [AFP], Child−Pugh CP]) score. Results: Among 1435 patients, median TBS was 5.1 (interquartile range [IQR]: 3.2−8.1), median AFP was 18.3 ng/ml (IQR 4.0−362.5), and 1391 (96.9%) patients were classified as CP-A. Factors associated with overall survival (OS) included TBS (low: referent; medium: HR 2.26, 95% CI: 1.73−2.96; high: HR = 3.35, 95% CI: 2.22−5.07), AFP (<400 ng/ml: referent; >400 ng/ml: HR = 1.56, 95% CI: 1.27−1.92), and CP (A: referent; B: HR = 1.81, 95% CI: 1.12−2.92) (all p < 0.05). A simplified risk score demonstrated superior concordance index, Akaike information criteria, homogeneity, and area under the curve versus BCLC (0.620 vs. 0.541; 5484.655 vs. 5536.454; 60.099 vs. 16.194; 0.62 vs. 0.55, respectively), and further stratified patients within BCLC groups relative to OS (BCLC 0, very low: 86.8%, low: 47.8%) (BCLC A, very low: 79.7%, low: 68.1%, medium: 52.5%, high: 35.6%) (BCLC B, low: 59.8%, medium: 43.7%, high: N/A). Conclusion: TAC is a simple, holistic score that consistently outperformed BCLC relative to discrimination power and prognostication following resection of HCC.",

keywords = "Barcelona clinic liver cancer, hepatocellular carcinoma, multi-institutional database, prognosis, resection, tumor burden score",

author = "Lima, {Henrique A.} and Yutaka Endo and Zorays Moazzam and Laura Alaimo and Chanza Shaikh and Munir, {Muhammad M.} and Vivian Resende and Alfredo Guglielmi and Marques, {Hugo P.} and Francois Cauchy and Vincent Lam and Poultsides, {George A.} and Irinel Popescu and Sorin Alexandrescu and Guillaume Martel and Itaru Endo and Minoru Kitago and Feng Shen and Pawlik, {Timothy M.}",

note = "Copyright the Author(s) 2022. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",

year = "2023",

month = mar,

doi = "10.1002/jso.27116",

language = "English",

volume = "127",

pages = "374--384",

journal = "Journal of Surgical Oncology",

issn = "0022-4790",

publisher = "Wiley-Liss, Wiley",

number = "3",

}

Lima, HA, Endo, Y, Moazzam, Z, Alaimo, L, Shaikh, C, Munir, MM, Resende, V, Guglielmi, A, Marques, HP, Cauchy, F, Lam, V, Poultsides, GA, Popescu, I, Alexandrescu, S, Martel, G, Endo, I, Kitago, M, Shen, F & Pawlik, TM 2023, 'TAC score better predicts survival than the BCLC following resection of hepatocellular carcinoma', Journal of Surgical Oncology, vol. 127, no. 3, pp. 374-384. https://doi.org/10.1002/jso.27116

TY - JOUR

T1 - TAC score better predicts survival than the BCLC following resection of hepatocellular carcinoma

AU - Lima, Henrique A.

AU - Endo, Yutaka

AU - Moazzam, Zorays

AU - Alaimo, Laura

AU - Shaikh, Chanza

AU - Munir, Muhammad M.

AU - Resende, Vivian

AU - Guglielmi, Alfredo

AU - Marques, Hugo P.

AU - Cauchy, Francois

AU - Lam, Vincent

AU - Poultsides, George A.

AU - Popescu, Irinel

AU - Alexandrescu, Sorin

AU - Martel, Guillaume

AU - Endo, Itaru

AU - Kitago, Minoru

AU - Shen, Feng

AU - Pawlik, Timothy M.

N1 - Copyright the Author(s) 2022. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2023/3

Y1 - 2023/3

N2 - Background: Heterogeneity in hepatocellular carcinoma (HCC) still exists within the Barcelona clinic liver cancer (BCLC) subcategories. We developed a simple model to better discriminate and predict prognosis following resection. Methods: Patients who underwent curative-intent resection for HCC were identified from a multi-institutional database. Predictive factors of survival were identified to develop TAC (tumor burden score [TBS], alpha-fetoprotein [AFP], Child−Pugh CP]) score. Results: Among 1435 patients, median TBS was 5.1 (interquartile range [IQR]: 3.2−8.1), median AFP was 18.3 ng/ml (IQR 4.0−362.5), and 1391 (96.9%) patients were classified as CP-A. Factors associated with overall survival (OS) included TBS (low: referent; medium: HR 2.26, 95% CI: 1.73−2.96; high: HR = 3.35, 95% CI: 2.22−5.07), AFP (<400 ng/ml: referent; >400 ng/ml: HR = 1.56, 95% CI: 1.27−1.92), and CP (A: referent; B: HR = 1.81, 95% CI: 1.12−2.92) (all p < 0.05). A simplified risk score demonstrated superior concordance index, Akaike information criteria, homogeneity, and area under the curve versus BCLC (0.620 vs. 0.541; 5484.655 vs. 5536.454; 60.099 vs. 16.194; 0.62 vs. 0.55, respectively), and further stratified patients within BCLC groups relative to OS (BCLC 0, very low: 86.8%, low: 47.8%) (BCLC A, very low: 79.7%, low: 68.1%, medium: 52.5%, high: 35.6%) (BCLC B, low: 59.8%, medium: 43.7%, high: N/A). Conclusion: TAC is a simple, holistic score that consistently outperformed BCLC relative to discrimination power and prognostication following resection of HCC.

AB - Background: Heterogeneity in hepatocellular carcinoma (HCC) still exists within the Barcelona clinic liver cancer (BCLC) subcategories. We developed a simple model to better discriminate and predict prognosis following resection. Methods: Patients who underwent curative-intent resection for HCC were identified from a multi-institutional database. Predictive factors of survival were identified to develop TAC (tumor burden score [TBS], alpha-fetoprotein [AFP], Child−Pugh CP]) score. Results: Among 1435 patients, median TBS was 5.1 (interquartile range [IQR]: 3.2−8.1), median AFP was 18.3 ng/ml (IQR 4.0−362.5), and 1391 (96.9%) patients were classified as CP-A. Factors associated with overall survival (OS) included TBS (low: referent; medium: HR 2.26, 95% CI: 1.73−2.96; high: HR = 3.35, 95% CI: 2.22−5.07), AFP (<400 ng/ml: referent; >400 ng/ml: HR = 1.56, 95% CI: 1.27−1.92), and CP (A: referent; B: HR = 1.81, 95% CI: 1.12−2.92) (all p < 0.05). A simplified risk score demonstrated superior concordance index, Akaike information criteria, homogeneity, and area under the curve versus BCLC (0.620 vs. 0.541; 5484.655 vs. 5536.454; 60.099 vs. 16.194; 0.62 vs. 0.55, respectively), and further stratified patients within BCLC groups relative to OS (BCLC 0, very low: 86.8%, low: 47.8%) (BCLC A, very low: 79.7%, low: 68.1%, medium: 52.5%, high: 35.6%) (BCLC B, low: 59.8%, medium: 43.7%, high: N/A). Conclusion: TAC is a simple, holistic score that consistently outperformed BCLC relative to discrimination power and prognostication following resection of HCC.

KW - Barcelona clinic liver cancer

KW - hepatocellular carcinoma

KW - multi-institutional database

KW - prognosis

KW - resection

KW - tumor burden score

UR - http://www.scopus.com/inward/record.url?scp=85139110313&partnerID=8YFLogxK

U2 - 10.1002/jso.27116

DO - 10.1002/jso.27116

M3 - Article

C2 - 36194039

SN - 0022-4790

VL - 127

SP - 374

EP - 384

JO - Journal of Surgical Oncology

JF - Journal of Surgical Oncology

IS - 3

ER -

TAC score better predicts survival than the BCLC following resection of hepatocellular carcinoma

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