Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
Liver Transplant and Hepatobiliary Surgery Unit, Sapienza University of Rome, UmbertoI Policlinic of Rome, Viale delPoliclinico 155, 00161, Rome, Italy.
J Gastrointest Surg. 2018 May;22(5):859-871. doi: 10.1007/s11605-018-3688-y. Epub 2018 Jan 19.
Dichotomous models like Milan Criteria represent the routinely used tools for predicting the outcome of patients with hepatocellular carcinoma (HCC). However, a paradigm shift from a dichotomous to continuous prognostic stratification should represent a good strategy for improving the prediction process. Recently, the tumor burden score (TBS) has been proposed for selecting patients with colorectal liver metastases. To date, TBS has not been validated in a large HCC population. The main objective of this study was to evaluate the prognostic power of TBS in an HCC population treated with different curative and palliative modalities.
Prospectively collected data from consecutive HCC patients managed in 24 institutions participating in the ITA.LI.CA group between Jan 2002 and Mar 2015 were analyzed (n = 4759). A sub-analysis focused on 3909 patients with the radiological evidence of vascular invasion or metastatic disease was also performed.
TBS demonstrated the best discriminative ability when compared to MC and other tumor-specific scores. At multivariable Cox regression analysis, TBS was an independent risk factor of overall survival, with a 6% increased risk for patient death for each point increase in TBS. At survival analysis, when TBS ≥ 8 was connected with MELD ≥ 15 and alpha-fetoprotein ≥ 1000 ng/mL, patients presenting all these three risk factors presented the worst results (p value < 0.0001).
Survival prediction of HCC patients was very well done using TBS model, even stratifying the population in relation to the presence of metastases and/or vascular invasion. TBS model was the best in terms of discriminatory ability and goodness of fit when compared with other continuous or binary variables. Its incorporation in a model composed by tumor- and liver function-related variables further increases its survival prediction.
二项式模型，如米兰标准，代表了预测肝细胞癌（HCC）患者预后的常用工具。然而，从二项式向连续的预后分层的范式转变应该是改善预测过程的一个好策略。最近，肿瘤负担评分（TBS）已被提出用于选择结直肠癌肝转移患者。迄今为止，TBS尚未在大型 HCC 人群中得到验证。本研究的主要目的是评估 TBS 在接受不同根治性和姑息性治疗方式的 HCC 人群中的预后能力。
分析了 2002 年 1 月至 2015 年 3 月期间，24 个参与 ITA.LI.CA 小组的机构连续管理的 HCC 患者的前瞻性收集数据（n=4759）。还对 3909 例有血管侵犯或转移性疾病的影像学证据的患者进行了亚分析。
与 MC 和其他肿瘤特异性评分相比，TBS 显示出最佳的区分能力。在多变量 Cox 回归分析中，TBS 是总生存期的独立危险因素，TBS 每增加 1 分，患者死亡的风险增加 6%。在生存分析中，当 TBS≥8 与 MELD≥15 和 alpha-胎蛋白≥1000ng/mL 相关时，所有这三种危险因素的患者表现出最差的结果（p 值<0.0001）。
使用 TBS 模型对 HCC 患者的生存预测非常准确，即使是在存在转移和/或血管侵犯的情况下对人群进行分层。与其他连续或二项变量相比，TBS 模型在区分能力和拟合优度方面表现最佳。将其纳入由肿瘤和肝功能相关变量组成的模型中，进一步提高了其生存预测能力。
