Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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.
See this image and copyright information in PMC

References

    1. Bruix J, Sherman M, Practice Guidelines Committee, American Association for the Study of Liver Diseases . Management of hepatocellular carcinoma. Hepatology. 2005;42(5):1208‐1236. - PubMed
    1. Guro H, Cho JY, Han HS, Yoon YS, Choi Y, Periyasamy M. Current status of laparoscopic liver resection for hepatocellular carcinoma. Clin Mol Hepatol. 2016;22(2):212‐218. - PMC - PubMed
    1. Yamazaki S, Takayama T. Management strategies to minimize mortality in liver resection for hepatocellular carcinoma. Jpn J Clin Oncol. 2017;47(10):899‐908. - PubMed
    1. Hyun MH, Lee YS, Kim JH, et al. Hepatic resection compared to chemoembolization in intermediate‐ to advanced‐stage hepatocellular carcinoma: a meta‐analysis of high‐quality studies. Hepatology. 2018;68(3):977‐993. - PubMed
    1. Zhaohui Z, Shunli S, Bin C, et al. Hepatic resection provides survival benefit for selected intermediate‐stage (BCLC‐B) hepatocellular carcinoma patients. Cancer Res Treat. 2019;51(1):65‐72. - PMC - PubMed

Substances