Tumor Burden Score and Serum Alpha-fetoprotein Subclassify Intermediate-Stage Hepatocellular Carcinoma

被引：16

作者：

Lima, Henrique A. ^{[1
,2
,3
]}

Endo, Yutaka ^{[1
,2
]}

Alaimo, Laura ^{[1
,2
,4
]}

Moazzam, Zorays ^{[1
,2
]}

Munir, Muhammad Musaab ^{[1
,2
]}

Shaikh, Chanza ^{[1
,2
]}

Resende, Vivian ^{[3
]}

Guglielmi, Alfredo ^{[4
]}

Marques, Hugo P. ^{[5
]}

Cauchy, Francois ^{[6
]}

Lam, Vincent ^{[7
]}

Poultsides, George A. ^{[8
]}

Popescu, Irinel ^{[9
]}

Alexandrescu, Sorin ^{[9
]}

Martel, Guillaume ^{[10
]}

Hugh, Tom ^{[11
]}

Endo, Itaru ^{[12
]}

Kitago, Minoru ^{[13
]}

Shen, Feng ^{[14
]}

Pawlik, Timothy M. ^{[1
,2
]}

机构：

[1] Ohio State Univ, Dept Surg, Wexner Med Ctr, 395 12th Ave,Suite 670, Columbus, OH 43210 USA

[2] James Comprehens Canc Ctr, 395 12th Ave,Suite 670, Columbus, OH 43210 USA

[3] Univ Fed Minas Gerais, Sch Med, Belo Horizonte, MG, Brazil

[4] Univ Verona, Dept Surg, Verona, Italy

[5] Curry Cabral Hosp, Dept Surg, Lisbon, Portugal

[6] Beaujon Hosp, AP HP, Dept Hepatibiliopancreat Surg, Clichy, France

[7] Westmead Hosp, Dept Surg, Sydney, NSW, Australia

[8] Stanford Univ, Dept Surg, Stanford, CA 94305 USA

[9] Fundeni Clin Inst, Dept Surg, Bucharest, Romania

[10] Univ Ottawa, Dept Surg, Ottawa, ON, Canada

[11] Univ Sydney, Sch Med, Dept Surg, Sydney, NSW, Australia

[12] Yokohama City Univ, Sch Med, Yokohama, Kanagawa, Japan

[13] Keio Univ, Dept Surg, Tokyo, Japan

[14] Eastern Hepatobiliary Surg Hosp, Shanghai, Peoples R China

来源：

JOURNAL OF GASTROINTESTINAL SURGERY | 2022年 / 26卷 / 12期

关键词：

Intermediate-stage hepatocellular carcinoma; BCLC B; Tumor burden score; Alpha-fetoprotein; Multi-institutional database; LIVER-TRANSPLANTATION; TRANSARTERIAL CHEMOEMBOLIZATION; SURGICAL RESECTION; MODEL; STRATIFICATION; RECURRENCE; SURVIVAL; PROPOSAL; OUTCOMES;

D O I：

10.1007/s11605-022-05469-9

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background Resection of Barcelona Clinic Liver Cancer (BCLC) intermediate-stage hepatocellular carcinoma (HCC) remains controversial. While not recommended by the BCLC algorithm, some patients may indeed benefit from hepatectomy. We sought to identify that subset of patients who might derive long-term survival benefit from resection. Methods Intermediate-stage HCC patients who underwent curative-intent resection were identified from an international multi-institutional database. Factors associated with long-term prognosis were identified using multivariate analysis and a risk score was developed and assessed. Results Among 194 patients, most individuals had two tumors (n = 123, 63.4%) with a median size of 6.0 cm (IQR, 4.0-8.4) for a median tumor burden score (TBS) of 6.5 (IQR, 5.0-9.1); median alpha-fetoprotein (AFP) was 23.9 ng/mL (IQR, 5.0-503.2), and median overall survival (OS) was 69 months (IAR, 60.7-77.3). Factors associated with OS included AFP (referent <= 20 ng/mL, > 20 ng/mL: HR 1.78 95%CI, 1.09-2.89) and TBS (referent TBS <= 8.0, TBS > 8.0: HR 1.72 95%CI, 1.07-2.75). While 71 (36.6%) patients had neither risk factor, 79 (40.7%) and 44 (22.7%) had 1 or 2, respectively. A simplified score stratified patients relative to recurrence-free survival (RFS) (0: 33.6% vs. 1: 18.0% vs. 2: 14.7%) (AUC 0.60) and recurrence time (i.e., < 6 months after surgery) (0: 21.3% vs. 1: 43.1% vs. 2: 68.6%) (AUC 0.69) (both p < 0.001). Of note, a higher score was also associated with incrementally worse 5-year OS (0: 68.1% vs. 1: 61.0% vs. 2: 29.9%) (AUC 0.62) (p < 0.001). Conclusion Long-term OS and RFS outcomes varied considerably. Using a simple risk score, patients with low AFP and low TBS were identified as the subset of individuals most likely to benefit from resection.

引用

页码：2512 / 2521

页数：10

共 39 条

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