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Recurrence beyond the Milan criteria after curative-intent resection of hepatocellular carcinoma: A novel tumor-burden based prediction model.
J Surg Oncol. 2020 Jun 29 [Online ahead of print]JS

Abstract

BACKGROUND

Accurate prediction of recurrence patterns of hepatocellular carcinoma (HCC) may allow for prioritization of patients for resection or transplantation as well as guide post-resection surveillance strategies.

METHODS

Patients who underwent curative-intent R0 resection for HCC between 2000 and 2017 were identified using a multi-institutional database. A prognostic model that incorporated HCC tumor burden score (TBS) to predict recurrence beyond the Milan criteria (MC) was developed and validated.

RESULTS

Among 718 patients who underwent R0 resection for HCC, 185 (25.8%) recurred within and 110 (15.3%) beyond the MC. On multivariable analysis, AFP more than 400 ng/mL (hazard ratio [HR] = 2.26; 95% confidence interval [CI]: 1.27-4.02), lymphovascular invasion (HR = 2.00; 95% CI: 1.14-3.50), and TBS (HR = 1.08; 95% CI: 1.03-1.12) were associated with recurrence beyond the MC. A weighted TBS-based score was constructed: [0.074*TBS + 0.692*lymphovascular invasion (yes: 1, no: 0) + 0.816*AFP > 400 (yes:1, no:0)]. Patients with a low, medium, and high TBS-based risk score had a 5-year incidence of recurring beyond the MC of 16.2%, 28.6%, and 47.2%, respectively (P < .001). The predictive accuracy of the model was very good in the training (C-index: 0.761) and validation (C-index: 0.706) datasets and outperformed the previously reported clinical risk score (CRS; C-index: 0.680).

CONCLUSION

A TBS-based model accurately predicted recurrence beyond MC after curative-intent resection of HCC and outperformed the CRS. Incorporating TBS allows for better risk stratification and identifies patients in need of closer surveillance.

Authors+Show Affiliations

Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.Department of Surgery, University of Verona, Verona, Italy.Department of Surgery, Ospedale San Raffaele, Milano, Italy.Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal.Department of Hepatobiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France.Department of Surgery, Westmead Hospital, Sydney, Australia.Department of Surgery, Stanford University, Stanford, California.Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania.Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania.Department of Surgery, University of Ottawa, Ottawa, Canada.Department of Surgery, School of Medicine, The University of Sydney, Sydney, Australia.Department of Surgery, Ospedale San Raffaele, Milano, Italy.Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan.Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32602143

Citation

Tsilimigras, Diamantis I., et al. "Recurrence Beyond the Milan Criteria After Curative-intent Resection of Hepatocellular Carcinoma: a Novel Tumor-burden Based Prediction Model." Journal of Surgical Oncology, 2020.
Tsilimigras DI, Mehta R, Guglielmi A, et al. Recurrence beyond the Milan criteria after curative-intent resection of hepatocellular carcinoma: A novel tumor-burden based prediction model. J Surg Oncol. 2020.
Tsilimigras, D. I., Mehta, R., Guglielmi, A., Ratti, F., Marques, H. P., Soubrane, O., Lam, V., Poultsides, G. A., Popescu, I., Alexandrescu, S., Martel, G., Hugh, T., Aldrighetti, L., Endo, I., & Pawlik, T. M. (2020). Recurrence beyond the Milan criteria after curative-intent resection of hepatocellular carcinoma: A novel tumor-burden based prediction model. Journal of Surgical Oncology. https://doi.org/10.1002/jso.26091
Tsilimigras DI, et al. Recurrence Beyond the Milan Criteria After Curative-intent Resection of Hepatocellular Carcinoma: a Novel Tumor-burden Based Prediction Model. J Surg Oncol. 2020 Jun 29; PubMed PMID: 32602143.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recurrence beyond the Milan criteria after curative-intent resection of hepatocellular carcinoma: A novel tumor-burden based prediction model. AU - Tsilimigras,Diamantis I, AU - Mehta,Rittal, AU - Guglielmi,Alfredo, AU - Ratti,Francesca, AU - Marques,Hugo P, AU - Soubrane,Olivier, AU - Lam,Vincent, AU - Poultsides,George A, AU - Popescu,Irinel, AU - Alexandrescu,Sorin, AU - Martel,Guillaume, AU - Hugh,Tom, AU - Aldrighetti,Luca, AU - Endo,Itaru, AU - Pawlik,Timothy M, Y1 - 2020/06/29/ PY - 2020/06/06/received PY - 2020/06/13/accepted PY - 2020/7/1/entrez KW - HCC KW - Milan KW - recurrence KW - tumor burden JF - Journal of surgical oncology JO - J Surg Oncol N2 - BACKGROUND: Accurate prediction of recurrence patterns of hepatocellular carcinoma (HCC) may allow for prioritization of patients for resection or transplantation as well as guide post-resection surveillance strategies. METHODS: Patients who underwent curative-intent R0 resection for HCC between 2000 and 2017 were identified using a multi-institutional database. A prognostic model that incorporated HCC tumor burden score (TBS) to predict recurrence beyond the Milan criteria (MC) was developed and validated. RESULTS: Among 718 patients who underwent R0 resection for HCC, 185 (25.8%) recurred within and 110 (15.3%) beyond the MC. On multivariable analysis, AFP more than 400 ng/mL (hazard ratio [HR] = 2.26; 95% confidence interval [CI]: 1.27-4.02), lymphovascular invasion (HR = 2.00; 95% CI: 1.14-3.50), and TBS (HR = 1.08; 95% CI: 1.03-1.12) were associated with recurrence beyond the MC. A weighted TBS-based score was constructed: [0.074*TBS + 0.692*lymphovascular invasion (yes: 1, no: 0) + 0.816*AFP > 400 (yes:1, no:0)]. Patients with a low, medium, and high TBS-based risk score had a 5-year incidence of recurring beyond the MC of 16.2%, 28.6%, and 47.2%, respectively (P < .001). The predictive accuracy of the model was very good in the training (C-index: 0.761) and validation (C-index: 0.706) datasets and outperformed the previously reported clinical risk score (CRS; C-index: 0.680). CONCLUSION: A TBS-based model accurately predicted recurrence beyond MC after curative-intent resection of HCC and outperformed the CRS. Incorporating TBS allows for better risk stratification and identifies patients in need of closer surveillance. SN - 1096-9098 UR - https://www.unboundmedicine.com/medline/citation/32602143/Recurrence_beyond_the_Milan_criteria_after_curative-intent_resection_of_hepatocellular_carcinoma:_A_novel_tumor-burden_based_prediction_model L2 - https://doi.org/10.1002/jso.26091 DB - PRIME DP - Unbound Medicine ER -
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