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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2020

01-03-2020 | Hepatocellular Carcinoma | Hepatobiliary Tumors

Utilizing Machine Learning for Pre- and Postoperative Assessment of Patients Undergoing Resection for BCLC-0, A and B Hepatocellular Carcinoma: Implications for Resection Beyond the BCLC Guidelines

Authors: Diamantis I. Tsilimigras, MD, Rittal Mehta, MPH, Dimitrios Moris, MD, PhD, Kota Sahara, MD, Fabio Bagante, MD, Anghela Z. Paredes, MD, MS, Ayesha Farooq, MD, Francesca Ratti, MD, Hugo P. Marques, MD, Silvia Silva, MD, Olivier Soubrane, MD, Vincent Lam, MD, George A. Poultsides, MD, Irinel Popescu, MD, Razvan Grigorie, MD, PhD, Sorin Alexandrescu, MD, Guillaume Martel, MD, Aklile Workneh, MD, Alfredo Guglielmi, MD, Tom Hugh, MD, Luca Aldrighetti, MD, Itaru Endo, MD, PhD, Timothy M. Pawlik, MD, MPH, PhD, FACS, FRACS (Hon.)

Published in: Annals of Surgical Oncology | Issue 3/2020

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Abstract

Background

There is an ongoing debate about expanding the resection criteria for hepatocellular carcinoma (HCC) beyond the Barcelona Clinic Liver Cancer (BCLC) guidelines. We sought to determine the factors that held the most prognostic weight in the pre- and postoperative setting for each BCLC stage by applying a machine learning method.

Methods

Patients who underwent resection for BCLC-0, A and B HCC between 2000 and 2017 were identified from an international multi-institutional database. A Classification and Regression Tree (CART) model was used to generate homogeneous groups of patients relative to overall survival (OS) based on pre- and postoperative factors.

Results

Among 976 patients, 63 (6.5%) had BCLC-0, 745 (76.3%) had BCLC-A, and 168 (17.2%) had BCLC-B HCC. Five-year OS among BCLC-0/A and BCLC-B patients was 64.2% versus 50.2%, respectively (p = 0.011). The preoperative CART model selected α-fetoprotein (AFP) and Charlson comorbidity score (CCS) as the first and second most important preoperative factors of OS among BCLC-0/A patients, whereas radiologic tumor burden score (TBS) was the best predictor of OS among BCLC-B patients. The postoperative CART model revealed lymphovascular invasion as the best postoperative predictor of OS among BCLC-0/A patients, whereas TBS remained the best predictor of long-term outcomes among BCLC-B patients in the postoperative setting. On multivariable analysis, pathologic TBS independently predicted worse OS among BCLC-0/A (hazard ratio [HR] 1.04, 95% confidence interval [CI] 1.02–1.07) and BCLC-B patients (HR 1.13, 95% CI 1.06–1.19) undergoing resection.

Conclusion

Prognostic stratification of patients undergoing resection for HCC within and beyond the BCLC resection criteria should include assessment of AFP and comorbidities for BCLC-0/A patients, as well as tumor burden for BCLC-B patients.
Appendix
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Literature
1.
Fujiwara N, Friedman SL, Goossens N, Hoshida Y. Risk factors and prevention of hepatocellular carcinoma in the era of precision medicine. J Hepatol. 2018;68(3):526–49.PubMedCrossRef
2.
Petrick JL, Kelly SP, Altekruse SF, McGlynn KA, Rosenberg PS. Future of Hepatocellular Carcinoma Incidence in the United States Forecast Through 2030. Journal of clinical oncology. 2016;34(15):1787–94.PubMedPubMedCentralCrossRef
3.
Marrero JA, Fontana RJ, Barrat A, et al. Prognosis of hepatocellular carcinoma: comparison of 7 staging systems in an American cohort. Hepatology. 2005;41(4):707–16.PubMedCrossRef
4.
O’Neil BH, Venook AP. Hepatocellular carcinoma: the role of the North American GI Steering Committee Hepatobiliary Task Force and the advent of effective drug therapy. Oncologist. 2007;12(12):1425–32.PubMedCrossRef
5.
Cillo U, Vitale A, Grigoletto F, et al. Prospective validation of the Barcelona Clinic Liver Cancer staging system. J Hepatol. 2006;44(4):723–31.PubMedCrossRef
6.
European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182–236.CrossRef
7.
Marrero JA, Kulik LM, Sirlin CB, et al. Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2018;68(2):723–50.PubMedCrossRef
8.
Torzilli G, Belghiti J, Kokudo N, et al. A snapshot of the effective indications and results of surgery for hepatocellular carcinoma in tertiary referral centers: is it adherent to the EASL/AASLD recommendations? An observational study of the HCC East-West study group. Ann Surg. 2013;257(5):929–37.PubMedCrossRef
9.
McCormack L, Petrowsky H, Clavien PA. Surgical therapy of hepatocellular carcinoma. Eur J Gastroenterol Hepatol. 2005;17(5):497–503.PubMedCrossRef
10.
Wada H, Eguchi H, Noda T, et al. Selection criteria for hepatic resection in intermediate-stage (BCLC stage B) multiple hepatocellular carcinoma. Surgery. 2016;160(5):1227–35.PubMedCrossRef
11.
Guo H, Wu T, Lu Q, et al. Surgical resection improves long-term survival of patients with hepatocellular carcinoma across different Barcelona Clinic Liver Cancer stages. Cancer Manag Res. 2018;10:361–69.PubMedPubMedCentralCrossRef
12.
Strasberg SM. Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg. 2005;12(5):351–5.PubMedCrossRef
13.
Sasaki K, Morioka D, Conci S, et al. The Tumor Burden Score: A New “Metro-ticket” Prognostic Tool For Colorectal Liver Metastases Based on Tumor Size and Number of Tumors. Ann Surg. 2018;267(1):132–41.PubMedCrossRef
14.
Breiman L. Classification and regression trees. Belmont, CA: Wadsworth International Group; 1984.
15.
Beal EW, Tumin D, Kabir A, et al. Trends in the Mortality of Hepatocellular Carcinoma in the United States. J Gastrointest Surg. 2017;21(12):2033–38.PubMedCrossRef
16.
Cho Y, Sinn DH, Yu SJ, et al. Survival Analysis of Single Large (> 5 cm) Hepatocellular Carcinoma Patients: BCLC A versus B. PLoS One. 2016;11(11):e0165722.PubMedPubMedCentralCrossRef
17.
Tsilimigras DI, Bagante F, Sahara K, et al. Prognosis after Resection for Barcelona Clinic Liver Cancer (BCLC) Stage 0, A and B Hepatocellular Carcinoma: A Comprehensive Assessment of the Current BCLC Classification. Ann Surg Oncol. 2019;26(11):3693–700.PubMedCrossRef
18.
Ruan DY, Lin ZX, Wang TT, et al. Nomogram for preoperative estimation of long-term survival of patients who underwent curative resection with hepatocellular carcinoma beyond Barcelona clinic liver cancer stage A1. Oncotarget. 2016;7(38):61378–89.PubMedPubMedCentralCrossRef
19.
Vitale A, Lai Q, Farinati F, et al. 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. 2018;22(5):859–71.PubMedCrossRef
20.
Kim H, Ahn SW, Hong SK, et al. Survival benefit of liver resection for Barcelona Clinic Liver Cancer stage B hepatocellular carcinoma. Br J Surg. 2017;104(8):1045–52.PubMedCrossRef
21.
Liang L, Xing H, Zhang H, et al. Surgical resection versus transarterial chemoembolization for BCLC intermediate stage hepatocellular carcinoma: a systematic review and meta-analysis. HPB (Oxford). 2018;20(2):110–9.PubMedCrossRef
22.
Hyun MH, Lee YS, Kim JH, et al. Hepatic resection compared to chemoembolization in intermediate- to advanced-stage hepatocellular carcinoma: a meta-analysis of high-quality studies. Hepatology. 2018;68(3):977–93.PubMedCrossRef
23.
He S, Fan X, Ma H, et al. Effect of prophylactic TACE on 5-year survival of patients with hepatocellular carcinoma after hepatectomy. Oncol Lett. 2019;18(2):1824–30.PubMedPubMedCentral
24.
Huang SX, Wu YL, Tang CW, et al. Prophylactic hepatic artery infusion chemotherapy improved survival after curative resection in patients with hepatocellular carcinoma. Hepatogastroenterology. 2015;62(137):122–5.PubMed
Metadata
Title
Utilizing Machine Learning for Pre- and Postoperative Assessment of Patients Undergoing Resection for BCLC-0, A and B Hepatocellular Carcinoma: Implications for Resection Beyond the BCLC Guidelines
Authors
Diamantis I. Tsilimigras, MD
Rittal Mehta, MPH
Dimitrios Moris, MD, PhD
Kota Sahara, MD
Fabio Bagante, MD
Anghela Z. Paredes, MD, MS
Ayesha Farooq, MD
Francesca Ratti, MD
Hugo P. Marques, MD
Silvia Silva, MD
Olivier Soubrane, MD
Vincent Lam, MD
George A. Poultsides, MD
Irinel Popescu, MD
Razvan Grigorie, MD, PhD
Sorin Alexandrescu, MD
Guillaume Martel, MD
Aklile Workneh, MD
Alfredo Guglielmi, MD
Tom Hugh, MD
Luca Aldrighetti, MD
Itaru Endo, MD, PhD
Timothy M. Pawlik, MD, MPH, PhD, FACS, FRACS (Hon.)
Publication date
01-03-2020
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 3/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-08025-z

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