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 18.3ng/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 (<400ng/ml: referent; >400ng/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.

View details for DOI 10.1002/jso.27116

View details for PubMedID 36194039