TAC score better predicts survival than the BCLC following resection of hepatocellular carcinoma. Issue 3 (4th October 2022)

• Record Type: Journal Article
• Authors: Lima, Henrique A.; Endo, Yutaka; Moazzam, Zorays; Alaimo, Laura; Shaikh, Chanza; Munir, Muhammad M.; Resende, Vivian; Guglielmi, Alfredo; Marques, Hugo P.; Cauchy, François; Lam, Vincent; Poultsides, George A.; Popescu, Irinel; Alexandrescu, Sorin; Martel, Guillaume; Endo, Itaru; Kitago, Minoru; Shen, Feng; Pawlik, Timothy M.
• Is Part Of: Journal of surgical oncology. Volume 127:Issue 3(2023)
• Page Start: 374
• Page End: 384
• Publication Date: 2022-10-04
• Subjects: Barcelona clinic liver cancer -- hepatocellular carcinoma -- multi‐institutional database -- prognosis -- resection -- tumor burden score; Cancer -- Surgery -- Periodicals; Neoplasms -- Periodicals; 616
• DOI: 10.1002/jso.27116
• Languages: English
• ISSNs: 0022-4790

Abstract

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.