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. 2023 Mar;127(3):374-384.
doi: 10.1002/jso.27116. Epub 2022 Oct 4.

TAC score better predicts survival than the BCLC following resection of hepatocellular carcinoma

Henrique A Lima  1   2 , Yutaka Endo  1 , Zorays Moazzam  1 , Laura Alaimo  1 , Chanza Shaikh  1 , Muhammad M Munir  1 , Vivian Resende  2 , Alfredo Guglielmi  3 , Hugo P Marques  4 , François Cauchy  5 , Vincent Lam  6 , George A Poultsides  7 , Irinel Popescu  8 , Sorin Alexandrescu  8 , Guillaume Martel  9 , Itaru Endo  10 , Minoru Kitago  11 , Feng Shen  12 , Timothy M Pawlik  1
Affiliations

TAC score better predicts survival than the BCLC following resection of hepatocellular carcinoma

Henrique A Lima et al. J Surg Oncol. 2023 Mar.

Abstract

Background: Heterogeneity in hepatocellular carcinoma (HCC) still exists within the Barcelona clinic liver cancer (BCLC) subcategories. We developed a simple model to better discriminate and predict prognosis following resection.

Methods: Patients who underwent curative-intent resection for HCC were identified from a multi-institutional database. Predictive factors of survival were identified to develop TAC (tumor burden score [TBS], alpha-fetoprotein [AFP], Child-Pugh CP]) score.

Results: Among 1435 patients, median TBS was 5.1 (interquartile range [IQR]: 3.2-8.1), median AFP was 18.3 ng/ml (IQR 4.0-362.5), and 1391 (96.9%) patients were classified as CP-A. Factors associated with overall survival (OS) included TBS (low: referent; medium: HR 2.26, 95% CI: 1.73-2.96; high: HR = 3.35, 95% CI: 2.22-5.07), AFP (<400 ng/ml: referent; >400 ng/ml: HR = 1.56, 95% CI: 1.27-1.92), and CP (A: referent; B: HR = 1.81, 95% CI: 1.12-2.92) (all p < 0.05). A simplified risk score demonstrated superior concordance index, Akaike information criteria, homogeneity, and area under the curve versus BCLC (0.620 vs. 0.541; 5484.655 vs. 5536.454; 60.099 vs. 16.194; 0.62 vs. 0.55, respectively), and further stratified patients within BCLC groups relative to OS (BCLC 0, very low: 86.8%, low: 47.8%) (BCLC A, very low: 79.7%, low: 68.1%, medium: 52.5%, high: 35.6%) (BCLC B, low: 59.8%, medium: 43.7%, high: N/A).

Conclusion: TAC is a simple, holistic score that consistently outperformed BCLC relative to discrimination power and prognostication following resection of HCC.

Keywords: Barcelona clinic liver cancer; hepatocellular carcinoma; multi-institutional database; prognosis; resection; tumor burden score.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Estimated overall survival Kaplan−Meier curves stratified according to the TAC score (A) and the Barcelona clinic liver cancer (BCLC) system (B). Kaplan−Meier curves depict estimated recurrence‐free survival (C) and cumulative risk of death (D) according to the TAC score.
Figure 2
Figure 2
Sankey diagrams depicting patterns of recurrence according to the TAC score and recurrence category (A), time (B), site (C), and number (D)
Figure 3
Figure 3
Estimated overall survival Kaplan−Meier curves stratified according to the TAC score among BCLC 0 (A), BCLC A (B), and BCLC B (C) patients. BCLC, Barcelona clinic liver cancer.
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