Utility of Tumor Burden Score to Stratify Prognosis of Patients with Hepatocellular Cancer: Results of 4759 Cases from ITA.LI.CA Study Group

Alessandro Vitale, Quirino Lai, Fabio Farinati, Laura Bucci, Edoardo G. Giannini, Lucia Napoli, Francesca Ciccarese, Gian Lodovico Rapaccini, Maria Di Marco, Eugenio Caturelli, Marco Zoli, Franco Borzio, Rodolfo Sacco, Giuseppe Cabibbo, Roberto Virdone, Fabio Marra, Martina Felder, Filomena Morisco, Luisa Benvegnù, Antonio GasbarriniGianluca Svegliati-Baroni, Francesco Giuseppe Foschi, Gabriele Missale, Alberto Masotto, Gerardo Nardone, Antonio Colecchia, Mauro Bernardi, Franco Trevisani, Timothy M. Pawlik, On behalf of the Italian Liver Cancer (ITA.LI.CA) group

Research output: Contribution to journalArticle

Abstract

Background: 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. Methods: 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. Results: 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). Conclusions: 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.

Original languageEnglish
Pages (from-to)859-871
Number of pages13
JournalJournal of Gastrointestinal Surgery
Volume22
Issue number5
DOIs
Publication statusPublished - 2018

Fingerprint

Liver Neoplasms
Tumor Burden
Hepatocellular Carcinoma
Blood Vessels
Survival
Population
Neoplasm Metastasis
Mars
Liver
alpha-Fetoproteins
Survival Analysis
Neoplasms
Regression Analysis

Keywords

  • Hepatocellular carcinoma
  • Milan Criteria
  • Outcomes
  • Prognosis
  • Tumor burden

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Utility of Tumor Burden Score to Stratify Prognosis of Patients with Hepatocellular Cancer : Results of 4759 Cases from ITA.LI.CA Study Group. / Vitale, Alessandro; Lai, Quirino; Farinati, Fabio; Bucci, Laura; Giannini, Edoardo G.; Napoli, Lucia; Ciccarese, Francesca; Rapaccini, Gian Lodovico; Di Marco, Maria; Caturelli, Eugenio; Zoli, Marco; Borzio, Franco; Sacco, Rodolfo; Cabibbo, Giuseppe; Virdone, Roberto; Marra, Fabio; Felder, Martina; Morisco, Filomena; Benvegnù, Luisa; Gasbarrini, Antonio; Svegliati-Baroni, Gianluca; Foschi, Francesco Giuseppe; Missale, Gabriele; Masotto, Alberto; Nardone, Gerardo; Colecchia, Antonio; Bernardi, Mauro; Trevisani, Franco; Pawlik, Timothy M.; On behalf of the Italian Liver Cancer (ITA.LI.CA) group.

In: Journal of Gastrointestinal Surgery, Vol. 22, No. 5, 2018, p. 859-871.

Research output: Contribution to journalArticle

Vitale, A, Lai, Q, Farinati, F, Bucci, L, Giannini, EG, Napoli, L, Ciccarese, F, Rapaccini, GL, Di Marco, M, Caturelli, E, Zoli, M, Borzio, F, Sacco, R, Cabibbo, G, Virdone, R, Marra, F, Felder, M, Morisco, F, Benvegnù, L, Gasbarrini, A, Svegliati-Baroni, G, Foschi, FG, Missale, G, Masotto, A, Nardone, G, Colecchia, A, Bernardi, M, Trevisani, F, Pawlik, TM & On behalf of the Italian Liver Cancer (ITA.LI.CA) group 2018, 'Utility of Tumor Burden Score to Stratify Prognosis of Patients with Hepatocellular Cancer: Results of 4759 Cases from ITA.LI.CA Study Group', Journal of Gastrointestinal Surgery, vol. 22, no. 5, pp. 859-871. https://doi.org/10.1007/s11605-018-3688-y
Vitale, Alessandro ; Lai, Quirino ; Farinati, Fabio ; Bucci, Laura ; Giannini, Edoardo G. ; Napoli, Lucia ; Ciccarese, Francesca ; Rapaccini, Gian Lodovico ; Di Marco, Maria ; Caturelli, Eugenio ; Zoli, Marco ; Borzio, Franco ; Sacco, Rodolfo ; Cabibbo, Giuseppe ; Virdone, Roberto ; Marra, Fabio ; Felder, Martina ; Morisco, Filomena ; Benvegnù, Luisa ; Gasbarrini, Antonio ; Svegliati-Baroni, Gianluca ; Foschi, Francesco Giuseppe ; Missale, Gabriele ; Masotto, Alberto ; Nardone, Gerardo ; Colecchia, Antonio ; Bernardi, Mauro ; Trevisani, Franco ; Pawlik, Timothy M. ; On behalf of the Italian Liver Cancer (ITA.LI.CA) group. / Utility of Tumor Burden Score to Stratify Prognosis of Patients with Hepatocellular Cancer : Results of 4759 Cases from ITA.LI.CA Study Group. In: Journal of Gastrointestinal Surgery. 2018 ; Vol. 22, No. 5. pp. 859-871.
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title = "Utility of Tumor Burden Score to Stratify Prognosis of Patients with Hepatocellular Cancer: Results of 4759 Cases from ITA.LI.CA Study Group",
abstract = "Background: 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. Methods: 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. Results: 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). Conclusions: 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.",
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author = "Alessandro Vitale and Quirino Lai and Fabio Farinati and Laura Bucci and Giannini, {Edoardo G.} and Lucia Napoli and Francesca Ciccarese and Rapaccini, {Gian Lodovico} and {Di Marco}, Maria and Eugenio Caturelli and Marco Zoli and Franco Borzio and Rodolfo Sacco and Giuseppe Cabibbo and Roberto Virdone and Fabio Marra and Martina Felder and Filomena Morisco and Luisa Benvegn{\`u} and Antonio Gasbarrini and Gianluca Svegliati-Baroni and Foschi, {Francesco Giuseppe} and Gabriele Missale and Alberto Masotto and Gerardo Nardone and Antonio Colecchia and Mauro Bernardi and Franco Trevisani and Pawlik, {Timothy M.} and {On behalf of the Italian Liver Cancer (ITA.LI.CA) group}",
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T1 - Utility of Tumor Burden Score to Stratify Prognosis of Patients with Hepatocellular Cancer

T2 - Results of 4759 Cases from ITA.LI.CA Study Group

AU - Vitale, Alessandro

AU - Lai, Quirino

AU - Farinati, Fabio

AU - Bucci, Laura

AU - Giannini, Edoardo G.

AU - Napoli, Lucia

AU - Ciccarese, Francesca

AU - Rapaccini, Gian Lodovico

AU - Di Marco, Maria

AU - Caturelli, Eugenio

AU - Zoli, Marco

AU - Borzio, Franco

AU - Sacco, Rodolfo

AU - Cabibbo, Giuseppe

AU - Virdone, Roberto

AU - Marra, Fabio

AU - Felder, Martina

AU - Morisco, Filomena

AU - Benvegnù, Luisa

AU - Gasbarrini, Antonio

AU - Svegliati-Baroni, Gianluca

AU - Foschi, Francesco Giuseppe

AU - Missale, Gabriele

AU - Masotto, Alberto

AU - Nardone, Gerardo

AU - Colecchia, Antonio

AU - Bernardi, Mauro

AU - Trevisani, Franco

AU - Pawlik, Timothy M.

AU - On behalf of the Italian Liver Cancer (ITA.LI.CA) group

PY - 2018

Y1 - 2018

N2 - Background: 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. Methods: 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. Results: 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). Conclusions: 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.

AB - Background: 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. Methods: 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. Results: 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). Conclusions: 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.

KW - Hepatocellular carcinoma

KW - Milan Criteria

KW - Outcomes

KW - Prognosis

KW - Tumor burden

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