TBS-based preoperative score to predict non-transplantable recurrence and identify candidates for upfront resection versus transplantation for hepatocellular carcinoma

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

doi:10.1245/s10434-023-13273-1

TBS-based preoperative score to predict non-transplantable recurrence and identify candidates for upfront resection versus transplantation for hepatocellular carcinoma

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

^*Corresponding author for this work

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

21 Citations (Scopus)

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.

Original language	English
Pages (from-to)	3363-3373
Number of pages	11
Journal	Annals of Surgical Oncology
Volume	30
Issue number	6
Early online date	23 Feb 2023
DOIs	https://doi.org/10.1245/s10434-023-13273-1
Publication status	Published - Jun 2023
Externally published	Yes

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10.1245/s10434-023-13273-1

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Lima, H. A., Moazzam, Z., Endo, Y., 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., Hugh, T., Endo, I., Kitago, M., Shen, F., & Pawlik, T. M. (2023). TBS-based preoperative score to predict non-transplantable recurrence and identify candidates for upfront resection versus transplantation for hepatocellular carcinoma. Annals of Surgical Oncology, 30(6), 3363-3373. https://doi.org/10.1245/s10434-023-13273-1

@article{fc800e062fac4add83769aff34a2dfb3,

title = "TBS-based preoperative score to predict non-transplantable recurrence and identify candidates for upfront resection versus transplantation for hepatocellular carcinoma",

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.",

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

year = "2023",

month = jun,

doi = "10.1245/s10434-023-13273-1",

language = "English",

volume = "30",

pages = "3363--3373",

journal = "Annals of Surgical Oncology",

issn = "1068-9265",

publisher = "Springer, Springer Nature",

number = "6",

}

Lima, HA, Moazzam, Z, Endo, Y, Alaimo, L, Shaikh, C, Munir, MM, Resende, V, Guglielmi, A, Marques, HP, Cauchy, F, Lam, V, Poultsides, GA, Popescu, I, Alexandrescu, S, Martel, G, Hugh, T, Endo, I, Kitago, M, Shen, F & Pawlik, TM 2023, 'TBS-based preoperative score to predict non-transplantable recurrence and identify candidates for upfront resection versus transplantation for hepatocellular carcinoma', Annals of Surgical Oncology, vol. 30, no. 6, pp. 3363-3373. https://doi.org/10.1245/s10434-023-13273-1

TY - JOUR

T1 - TBS-based preoperative score to predict non-transplantable recurrence and identify candidates for upfront resection versus transplantation for hepatocellular carcinoma

AU - Lima, Henrique A.

AU - Moazzam, Zorays

AU - Endo, Yutaka

AU - Alaimo, Laura

AU - Shaikh, Chanza

AU - Munir, Muhammad Musaab

AU - Resende, Vivian

AU - Guglielmi, Alfredo

AU - Marques, Hugo P.

AU - Cauchy, François

AU - Lam, Vincent

AU - Poultsides, George A.

AU - Popescu, Irinel

AU - Alexandrescu, Sorin

AU - Martel, Guillaume

AU - Hugh, Tom

AU - Endo, Itaru

AU - Kitago, Minoru

AU - Shen, Feng

AU - Pawlik, Timothy M.

PY - 2023/6

Y1 - 2023/6

N2 - 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.

AB - 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.

UR - https://www.scopus.com/pages/publications/85148643708

U2 - 10.1245/s10434-023-13273-1

DO - 10.1245/s10434-023-13273-1

M3 - Article

C2 - 36820934

AN - SCOPUS:85148643708

SN - 1068-9265

VL - 30

SP - 3363

EP - 3373

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

IS - 6

ER -

TBS-based preoperative score to predict non-transplantable recurrence and identify candidates for upfront resection versus transplantation for hepatocellular carcinoma

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