ASO Author Reflections: TBS-Based Preoperative Score to Predict Non-Transplantable Recurrence and Identify Candidates for Upfront Resection Versus Transplantation for Hepatocellular Carcinoma

PIVKA‐II combined with tumor burden score to predict long‐term outcomes of AFP‐negative hepatocellular carcinoma patients after liver resection

“…Some traditional HCC staging systems (e.g., BCLC and AJCC TNM stage) that currently are used for guiding the clinical treatment strategy are focused on the tumor morphological behaviors of HCC and ignore the biological behaviors of HCC, which results in some controversies in screening HCC patients suitable for surgery 32 . Therefore, some studies investigated the synergetic impact of morphological characteristics and biological characteristics (tumor markers, e.g., AFP) on long‐term outcomes of HCC patients after hepatectomy and demonstrated the good performance of the combination of TBS and AFP in stratifying the OS of HCC patients after liver resection 12,18,19,33,34 . However, there is no relevant study in AFP‐negative HCC patients after liver resection.…”

“…32 Therefore, some studies investigated the synergetic impact of morphological characteristics and biological characteristics (tumor markers, e.g., AFP) on long-term outcomes of HCC patients after hepatectomy and demonstrated the good performance of the combination of TBS and AFP in stratifying the OS of HCC patients after liver resection. 12,18,19,33,34 relationship between the synergetic impact of combining TBS and PIVKA-II and survival outcomes of AFPnegative HCC patients within BCLC 0/A/B after liver resection. We established a simple prognostic scoring model (TPS model) based on TBS and preoperative PIVKA-II levels and demonstrated that the TPS model had excellent performance in stratifying OS and early recurrence in AFP-negative HCC patients after liver resection.…”

Frontline resection or liver transplantation in patients with single‐nodule hepatocellular carcinoma

“…Another multicenter study including 293 patients with early‐stage HCC under Milan criteria undergoing upfront liver resection 19 found underlying liver cirrhosis, tumour diameter larger than 3 cm and multiple lesions as risk factors with incrementally worse non‐transplantable recurrence rates: 4.5% without risk factors, 13.3% in presence of 1 risk factor, and 20.5% in presence of 2 or 3 risk factors. The authors concluded that patients with ≥2 risk factors would be better candidates for upfront LT instead of liver resection, even though the reported non‐transplantable recurrence rates for this subpopulation were lower than that observed in the high‐risk groups of Pelizzaro et al 1 and Lima et al 18 …”

“…Previous studies have identified additional pathological risk factors of tumour recurrence such as invasion of the surgical margin and poor histological tumour differentiation 17 . There is controversy about how to combine preoperative information with pathological data to identify candidates for upfront LT or ab initio LT, instead of a follow‐up with salvage LT as a safety net which will inevitably fail in at least one in five patients 18 . In a recent study, Lima et al trained and internally validated the NTR score aimed to predict non‐transplantable recurrence in patients with HCC undergoing liver resection 18 .…”

“…There is controversy about how to combine preoperative information with pathological data to identify candidates for upfront LT or ab initio LT, instead of a follow‐up with salvage LT as a safety net which will inevitably fail in at least one in five patients 18 . In a recent study, Lima et al trained and internally validated the NTR score aimed to predict non‐transplantable recurrence in patients with HCC undergoing liver resection 18 . Unlike Pelizzaro et al, patients with more than one HCC nodule entered the study provided that the tumour was considered resectable.…”