Costentin Charlotte, Audureau Etienne, Park Young Nyun, Langella Serena, Vibert Eric, Laurent Alexis, Cauchy François, Scatton Olivier, Chirica Mircea, Rhaiem Rami, Boleslawski Emmanuel, di Tommaso Luca, Ferrero Alessandro, Yano Hirohisa, Akiba Jun, Donadon Matteo, Nebbia Martina, Detry Olivier, Honoré Pierre, Di Martino Marcello, Schwarz Lilian, Barbier Louise, Nault Jean-Charles, Rhee Hyungjin, Lim Chetana, Brustia Raffaele, Paradis Valérie, Guettier Catherine, Le Bail Brigitte, Okumura Shinya, Blanc Jean-Frédéric, Calderaro Julien
Grenoble Alpes University, Institute for Advanced Biosciences, Research Center UGA/Inserm U 1209/CNRS 5309, Gastroenterology, Hepatology and GI Oncology Department, Digidune, Grenoble Alpes University Hospital, La Tronche, France.
Service de Santé Publique, Assistance Publique Hôpitaux de Paris, Hôpital Henri Mondor, and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, Créteil, France.
Liver Int. 2023 Nov;43(11):2538-2547. doi: 10.1111/liv.15683. Epub 2023 Aug 14.
Surgical resection (SR) is a potentially curative treatment of hepatocellular carcinoma (HCC) hampered by high rates of recurrence. New drugs are tested in the adjuvant setting, but standardised risk stratification tools of HCC recurrence are lacking.
To develop and validate a simple scoring system to predict 2-year recurrence after SR for HCC.
2359 treatment-naïve patients who underwent SR for HCC in 17 centres in Europe and Asia between 2004 and 2017 were divided into a development (DS; n = 1558) and validation set (VS; n = 801) by random sampling of participating centres. The Early Recurrence Score (ERS) was generated using variables associated with 2-year recurrence in the DS and validated in the VS.
Variables associated with 2-year recurrence in the DS were (with associated points) alpha-fetoprotein (<10 ng/mL:0; 10-100: 2; >100: 3), size of largest nodule (≥40 mm: 1), multifocality (yes: 2), satellite nodules (yes: 2), vascular invasion (yes: 1) and surgical margin (positive R1: 2). The sum of points provided a score ranging from 0 to 11, allowing stratification into four levels of 2-year recurrence risk (Wolbers' C-indices 66.8% DS and 68.4% VS), with excellent calibration according to risk categories. Wolber's and Harrell's C-indices apparent values were systematically higher for ERS when compared to Early Recurrence After Surgery for Liver tumour post-operative model to predict time to early recurrence or recurrence-free survival.
ERS is a user-friendly staging system identifying four levels of early recurrence risk after SR and a robust tool to design personalised surveillance strategies and adjuvant therapy trials.
手术切除（SR）是肝细胞癌（HCC）一种潜在的治愈性治疗方法，但复发率高限制了其应用。新药正在辅助治疗环境中进行测试，但缺乏用于HCC复发的标准化风险分层工具。
开发并验证一种简单的评分系统，以预测HCC患者SR后2年的复发情况。
2004年至2017年间，在欧洲和亚洲17个中心接受HCC手术切除且未接受过治疗的2359例患者，通过对参与中心的随机抽样分为开发集（DS；n = 1558）和验证集（VS；n = 801）。使用与DS中2年复发相关的变量生成早期复发评分（ERS），并在VS中进行验证。
DS中与2年复发相关的变量（及相关分值）为甲胎蛋白（<10 ng/mL：0；10 - 100：2；>100：3）、最大结节大小（≥40 mm：1）、多灶性（是：2）、卫星结节（是：2）、血管侵犯（是：1）和手术切缘（阳性R1：2）。分值总和提供了一个范围从0到11的评分，可将2年复发风险分为四个级别（DS的Wolbers C指数为66.8%，VS为68.4%），根据风险类别校准良好。与用于预测肝肿瘤手术后早期复发时间或无复发生存期的术后模型相比，ERS的Wolber和Harrell C指数表观值系统地更高。
ERS是一种用户友好的分期系统，可识别SR后早期复发风险级别，是设计个性化监测策略和辅助治疗试验的有力工具。
