Top

Langenbeck's Archives of Surgery

Published in:

01-12-2023 | Hepatocellular Carcinoma | Research

Tumor burden score-AFP-albumin-bilirubin grade score predicts the survival of patients with hepatocellular carcinoma after liver resection

Authors: Zhan-Cheng Qiu, Chuan Li, Yu Zhang, Fei Xie, Yu Yu, Shu-Sheng Leng, Ting-Hao Chen, Tian-Fu Wen

Published in: Langenbeck's Archives of Surgery | Issue 1/2023

Abstract

Purpose

There is little information regarding the overall survival (OS) predictive ability of the combination of tumor burden score (TBS), α-fetoprotein (AFP), and albumin-bilirubin (ALBI) grade for patients with hepatocellular carcinoma (HCC). Here, we aimed to develop a model including TBS, AFP, and ALBI grade to predict HCC patient OS following liver resection.

Methods

Patients (N = 1556) from six centers were randomly divided 1:1 into training and validation sets. The X-Tile software was used to determine the optimal cutoff values. The time-dependent area under the receiver operating characteristic curve (AUROC) was calculated to assess the prognostic ability of the different models.

Results

In the training set, tumor differentiation, TBS, AFP, ALBI grade, and Barcelona Clinic Liver Cancer (BCLC) stage were independently related to OS. According to the coefficient values of TBS, AFP, and ALBI grade, we developed the TBS-AFP-ALBI (TAA) score using a simplified point system (0, 2 for low/high TBS, 0, 1 for low/high AFP and 0,1 for ALBI grade 1/2). Patients were further divided into low TAA (TAA ≤ 1), medium TAA (TAA = 2–3), and high TAA (TAA= 4) groups. TAA scores (low: referent; medium, HR = 1.994, 95% CI = 1.492–2.666; high, HR = 2.413, 95% CI = 1.630–3.573) were independently associated with patient survival in the validation set. The TAA scores showed higher AUROCs than BCLC stage for the prediction of 1-, 3-, and 5-year OS in both the training and validation sets.

Conclusion

TAA is a simple score that has better OS prediction performance than the BCLC stage in predicting OS for HCC patients after liver resection.

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424. https://doi.org/10.3322/caac.21492CrossRefPubMed

Xia C, Dong X, Li H, Cao M, Sun D, He S et al (2022) Cancer statistics in China and United States, 2022: profiles, trends, and determinants. Chin Med J (Engl) 135(5):584–590. https://doi.org/10.1097/CM9.0000000000002108CrossRefPubMed

McGlynn KA, Petrick JL, El-Serag HB (2021) Epidemiology of hepatocellular carcinoma. Hepatology 73(Suppl 1):4–13. https://doi.org/10.1002/hep.31288CrossRefPubMed

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A et al (2021) Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71(3):209–249. https://doi.org/10.3322/caac.21660CrossRefPubMed

Wen T, Jin C, Facciorusso A, Donadon M, Han HS, Mao Y et al (2018) Multidisciplinary management of recurrent and metastatic hepatocellular carcinoma after resection: an international expert consensus. Hepatobiliary Surg Nutr 7(5):353-371. https://doi.org/10.21037/hbsn.2018.08.01

Sun J, Guo R, Bi X, Wu M, Tang Z, Lau WY et al (2022) Guidelines for diagnosis and treatment of hepatocellular carcinoma with portal vein tumor thrombus in China (2021 Edition). Liver Cancer 11(4):315–328. https://doi.org/10.1159/000523997CrossRefPubMedPubMedCentral

Elfadaly AN, Tsilimigras DI, Hyer JM, Paro A, Bagante F, Ratti F et al (2021) Impact of tumor burden score on conditional survival after curative-intent resection for hepatocellular carcinoma: a multi-institutional analysis. World J Surg 45(11):3438–3448. https://doi.org/10.1007/s00268-021-06265-3CrossRefPubMed

Tsilimigras DI, Moris D, Hyer JM, Bagante F, Sahara K, Moro A et al (2020) Hepatocellular carcinoma tumour burden score to stratify prognosis after resection. Br J Surg 107(7):854–864. https://doi.org/10.1002/bjs.11464CrossRefPubMed

Moris D, Shaw BI, McElroy L, Barbas AS (2020) Using hepatocellular carcinoma tumor burden score to stratify prognosis after liver transplantation. Cancers (Basel) 12(11). https://doi.org/10.3390/cancers12113372

10.

Ho SY, Liu PH, Hsu CY, Huang YH, Liao JI, Su CW et al (2022) Radiofrequency ablation versus transarterial chemoembolization for hepatocellular carcinoma within Milan criteria: prognostic role of tumor burden score. Cancers (Basel) 14(17). https://doi.org/10.3390/cancers14174207

11.

Wang J, Wu R, Sun JY, Lei F, Tan H, Lu X (2022) An overview: management of patients with advanced hepatocellular carcinoma. Biosci Trends 16(6):405–425. https://doi.org/10.5582/bst.2022.01109CrossRefPubMed

12.

Shimamura T, Akamatsu N, Fujiyoshi M, Kawaguchi A, Morita S, Kawasaki S et al (2019) Expanded living-donor liver transplantation criteria for patients with hepatocellular carcinoma based on the Japanese nationwide survey: the 5-5-500 rule — a retrospective study. Transpl Int 32(4):356–368. https://doi.org/10.1111/tri.13391CrossRefPubMed

13.

Vitale A, Lai Q, Farinati F, Bucci L, Giannini EG, Napoli L et al (2018) Utility of tumor burden score to stratify prognosis of patients with hepatocellular cancer: Results of 4759 Cases from ITA.LI.CA Study Group. J Gastrointest Surg 22(5):859–871. https://doi.org/10.1007/s11605-018-3688-yCrossRefPubMed

14.

Tsilimigras DI, Hyer JM, Diaz A, Bagante F, Ratti F, Marques HP et al (2021) Synergistic impact of alpha-fetoprotein and tumor burden on long-term outcomes following curative-intent resection of hepatocellular carcinoma. Cancers (Basel) 13(4). https://doi.org/10.3390/cancers13040747

15.

Sasaki K, Morioka D, Conci S, Margonis GA, Sawada Y, Ruzzenente A et al (2018) The tumor burden score: a new “metro-ticket” prognostic tool for colorectal liver metastases based on tumor size and number of tumors. Ann Surg 267(1):132–141. https://doi.org/10.1097/SLA.0000000000002064CrossRefPubMed

16.

Ho SY, Liu PH, Hsu CY, Ko CC, Huang YH, Su CW et al (2021) Tumor burden score as a new prognostic marker for patients with hepatocellular carcinoma undergoing transarterial chemoembolization. J Gastroenterol Hepatol 36(11):3196–3203. https://doi.org/10.1111/jgh.15593CrossRefPubMed

17.

Wang J, Chen Z, Wang L, Feng S, Qiu Q, Chen D et al (2022) A new model based inflammatory index and tumor burden score (TBS) to predict the recurrence of hepatocellular carcinoma (HCC) after liver resection. Sci Rep 12(1):8670. https://doi.org/10.1038/s41598-022-12518-5CrossRefPubMedPubMedCentral

18.

Ho SY, Liu PH, Hsu CY, Huang YH, Liao JI, Su CW et al (2022) A new tumor burden score and albumin-bilirubin grade-based prognostic model for hepatocellular carcinoma. Cancers (Basel) 14(3). https://doi.org/10.3390/cancers14030649

19.

Zhang W, Wang Y, Dong X, Yang B, Zhou H, Chen L et al (2022) Elevated serum CA19-9 indicates severe liver inflammation and worse survival after curative resection in hepatitis B-related hepatocellular carcinoma. Biosci Trends 15(6):397–405. https://doi.org/10.5582/bst.2021.01517CrossRefPubMed

20.

Liu S, Sun L, Yao L, Zhu H, Diao Y, Wang M et al (2022) Diagnostic performance of AFP, AFP-L3, or PIVKA-II for hepatitis C virus-associated hepatocellular carcinoma: a multicenter analysis. J Clin Med 11(17). https://doi.org/10.3390/jcm11175075

21.

Ge J, Zhang X, Zhang B, Zhu L, Zhao M, Gao W et al (2021) Higher tumor protein kinase D1 correlates with increased tumor size, BCLC stage, CA199 level, AFP level and worse overall survival in hepatocellular carcinoma patients. Clin Res Hepatol Gastroenterol 45(6):101573. https://doi.org/10.1016/j.clinre.2020.11.004CrossRefPubMed

22.

Menahem B, Duvoux C, Ganne N, Mallat A, Seror O, Calderaro J et al (2019) Liver resection for solitary transplantable hepatocellular carcinoma: the role of AFP-score. World J Surg 43(1):221–229. https://doi.org/10.1007/s00268-018-4769-5CrossRefPubMed

23.

Lu Y, Zhu M, Li W, Lin B, Dong X, Chen Y et al (2016) Alpha fetoprotein plays a critical role in promoting metastasis of hepatocellular carcinoma cells. J Cell Mol Med 20(3):549–558. https://doi.org/10.1111/jcmm.12745CrossRefPubMedPubMedCentral

24.

Hsu CY, Huang YH, Hsia CY, Su CW, Lin HC, Loong CC et al (2010) A new prognostic model for hepatocellular carcinoma based on total tumor volume: the Taipei Integrated Scoring System. J Hepatol 53(1):108–117. https://doi.org/10.1016/j.jhep.2010.01.038CrossRefPubMed

25.

Lee YH, Hsu CY, Huang YH, Su CW, Lin HC, Hsia CY et al (2013) alpha-fetoprotein-to-total tumor volume ratio predicts post-operative tumor recurrence in hepatocellular carcinoma. J Gastrointest Surg 17(4):730–738. https://doi.org/10.1007/s11605-012-2081-5CrossRefPubMed

26.

Johnson PJ, Berhane S, Kagebayashi C, Satomura S, Teng M, Reeves HL et al (2015) Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol 33(6):550–558. https://doi.org/10.1200/JCO.2014.57.9151CrossRefPubMed

27.

Zou H, Yang X, Li QL, Zhou QX, Xiong L, Wen Y (2018) A comparative study of albumin-bilirubin score with Child-Pugh score, model for end-stage liver disease score and indocyanine green R15 in predicting posthepatectomy liver failure for hepatocellular carcinoma patients. Dig Dis 36(3):236–243. https://doi.org/10.1159/000486590CrossRefPubMed

28.

Wang YY, Zhong JH, Su ZY, Huang JF, Lu SD, Xiang BD et al (2016) Albumin-bilirubin versus Child-Pugh score as a predictor of outcome after liver resection for hepatocellular carcinoma. Br J Surg 103(6):725–734. https://doi.org/10.1002/bjs.10095CrossRefPubMed

29.

Li C, Shen JY, Zhang XY, Peng W, Wen TF, Yang JY et al (2018) Predictors of futile liver resection for patients with Barcelona Clinic Liver Cancer stage B/C hepatocellular carcinoma. J Gastrointest Surg 22(3):496–502. https://doi.org/10.1007/s11605-017-3632-6CrossRefPubMed

30.

Li C, Wen TF, Yan LN, Li B, Wang WT, Yang JY et al (2015) Postoperative neutrophil-to-lymphocyte ratio plus platelet-to-lymphocyte ratio predicts the outcomes of hepatocellular carcinoma. J Surg Res 198(1):73–79. https://doi.org/10.1016/j.jss.2015.05.003CrossRefPubMed

31.

Yoshino K, Hamzaoui Y, Yoh T, Fteriche FS, Aussilhou B, Beaufrere A et al (2021) Liver resection for octogenarians in a French center: prolonged hepatic pedicle occlusion and male sex increase major complications. Langenbecks Arch Surg 406(5):1543–1552. https://doi.org/10.1007/s00423-021-02210-zCrossRefPubMed

32.

DeOliveira ML, Winter JM, Schafer M, Cunningham SC, Cameron JL, Yeo CJ et al (2006) Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 244(6):931–937. https://doi.org/10.1097/01.sla.0000246856.03918.9aCrossRefPubMedPubMedCentral

33.

Liu ZP, Yao LQ, Diao YK, Chen ZX, Feng ZH, Gu WM et al (2022) Association of preoperative body mass index with surgical textbook outcomes following hepatectomy for hepatocellular carcinoma: a multicenter study of 1206 patients. Ann Surg Oncol 29(7):4278–4286. https://doi.org/10.1245/s10434-022-11721-yCrossRef

34.

Ohta M, Nishizaki T, Matsumoto T, Shimabukuro R, Sasaki A, Shibata K et al (2005) Analysis of risk factors for massive intraoperative bleeding during laparoscopic splenectomy. J Hepatobiliary Pancreat Surg 12(6):433–437. https://doi.org/10.1007/s00534-005-1027-7CrossRefPubMed

35.

Toso C, Meeberg G, Hernandez-Alejandro R, Dufour JF, Marotta P, Majno P et al (2015) Total tumor volume and alpha-fetoprotein for selection of transplant candidates with hepatocellular carcinoma: a prospective validation. Hepatology. 62(1):158–165. https://doi.org/10.1002/hep.27787CrossRefPubMed

36.

Gu J, Zhang E, Liang B, Zhang Z, Chen X, Xiong M et al (2021) Liver collagen contents are closely associated with the severity of cirrhosis and posthepatectomy liver failure in patients with hepatocellular carcinoma and Child-Pugh grade A liver function. Ann Surg Oncol 28(8):4227–4235. https://doi.org/10.1245/s10434-020-09557-5CrossRefPubMed

37.

Shimizu T, Ishizuka M, Suzuki T, Tanaka G, Shiraki T, Sakuraoka Y et al (2018) The value of the C-reactive protein-to-albumin ratio is useful for predicting survival of patients with Child-Pugh class A undergoing liver resection for hepatocellular carcinoma. World J Surg 42(7):2218–2226. https://doi.org/10.1007/s00268-017-4446-0CrossRefPubMed

38.

Zhou P, Chen B, Miao XY, Zhou JJ, Xiong L, Wen Y et al (2020) Comparison of FIB-4 index and Child-Pugh score in predicting the outcome of hepatic resection for hepatocellular carcinoma. J Gastrointest Surg 24(4):823–831. https://doi.org/10.1007/s11605-019-04123-1CrossRefPubMed

39.

Qin L, Li C, Xie F, Wang Z, Wen T (2021) Combination of albumin-bilirubin grade and clinically significant portal hypertension predicts the prognosis of patients with hepatocellular carcinoma after liver resection. Biosci Trends 15(1):41–49. https://doi.org/10.5582/bst.2021.01064CrossRefPubMed

40.

Kumada T, Toyoda H, Tada T, Yasuda S, Tanaka J (2020) Changes in background liver function in patients with hepatocellular carcinoma over 30 years: comparison of Child-Pugh classification and albumin bilirubin grade. Liver Cancer 9(5):518–528. https://doi.org/10.1159/000507933CrossRefPubMedPubMedCentral

41.

Wang Z, Fan Q, Wang M, Wang E, Li H, Liu L (2020) Comparison between Child-Pugh score and albumin-bilirubin grade in patients treated with the combination therapy of transarterial chemoembolization and sorafenib for hepatocellular carcinoma. Ann Transl Med 8(8):537. https://doi.org/10.21037/atm.2020.02.114CrossRefPubMedPubMedCentral

42.

Ho SY, Hsu CY, Liu PH, Hsia CY, Lei HJ, Huang YH et al (2020) Albumin-bilirubin grade-based nomogram of the BCLC system for personalized prognostic prediction in hepatocellular carcinoma. Liver Int 40(1):205–214. https://doi.org/10.1111/liv.14249CrossRefPubMed

43.

Chan AW, Chong CC, Mo FK, Wong J, Yeo W, Johnson PJ et al (2016) Applicability of albumin-bilirubin-based Japan integrated staging score in hepatitis B-associated hepatocellular carcinoma. J Gastroenterol Hepatol 31(10):1766–1772. https://doi.org/10.1111/jgh.13339CrossRefPubMed

44.

Kluger MD, Salceda JA, Laurent A, Tayar C, Duvoux C, Decaens T et al (2015) Liver resection for hepatocellular carcinoma in 313 Western patients: tumor biology and underlying liver rather than tumor size drive prognosis. J Hepatol 62(5):1131–1140. https://doi.org/10.1016/j.jhep.2014.12.018CrossRefPubMed

45.

Duvoux C, Roudot-Thoraval F, Decaens T, Pessione F, Badran H, Piardi T et al (2012) Liver transplantation for hepatocellular carcinoma: a model including alpha-fetoprotein improves the performance of Milan criteria. Gastroenterology 143(4):986–994. https://doi.org/10.1053/j.gastro.2012.05.052CrossRefPubMed

Title: Tumor burden score-AFP-albumin-bilirubin grade score predicts the survival of patients with hepatocellular carcinoma after liver resection
Authors: Zhan-Cheng Qiu
Chuan Li
Yu Zhang
Fei Xie
Yu Yu
Shu-Sheng Leng
Ting-Hao Chen
Tian-Fu Wen
Publication date: 01-12-2023
Publisher: Springer Berlin Heidelberg
Keywords: Hepatocellular Carcinoma
Hepatocellular Carcinoma
Liver Resection
Liver Resection
Published in: Langenbeck's Archives of Surgery / Issue 1/2023
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-023-02993-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Tumor burden score-AFP-albumin-bilirubin grade score predicts the survival of patients with hepatocellular carcinoma after liver resection

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2023

Converting a probe-based fluorescence system into an easy-to-use adjunct for the detection of parathyroid glands accidentally resected intraoperatively

Accidental parathyroidectomy during total thyroidectomy and hypoparathyroidism in a large series of 766 patients: incidence and consequences in a referral center

Standardized lymph node dissection for gallbladder cancer under laparoscopy: en-bloc resection technique

The efficacy of adjuvant radioactive iodine after reoperation in patients with persistent or recurrent differentiated thyroid cancer: a systematic review

Sarcopenia and visceral fat in patients with incisional hernia after urgent laparotomy

Colonization of the gastric juice by Candida spp. promotes surgical site infection after hepatectomy