Predictors of early and late hepatocellular carcinoma recurrence

Nevola, Riccardo; Ruocco, Rachele; Criscuolo, Livio; Villani, Angela; Alfano, Maria Rosaria; Beccia, Domenico; Imbriani, Simona; Claar, Ernesto; Cozzolino, Domenico; Sasso, Ferdinando Carlo; Marrone, Aldo; Adinolfi, Luigi Elio; Rinaldi, Luca

doi:10.3748/wjg.v29.i8.1243

Cited by 51 publications

(42 citation statements)

References 144 publications

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“…However, the efficacy of surgical intervention is greatly compromised by postoperative recurrence, particularly early recurrence, which is defined as recurrence within 2 years after surgery. [3,4] Early recurrence serves as an indication of the aggressive nature of HCC, indicating the presence of residual tumor cells that survived the initial surgical intervention. These residual cells possess the ability to proliferate, invade neighboring tissues, and metastasize to distant sites, resulting in disease recurrence.…”

Section: Introductionmentioning

confidence: 99%

Revolutionising hepatocellular carcinoma surveillance: Harnessing contrast-enhanced ultrasound and serological indicators for postoperative early recurrence prediction

Tu,

Feng,

Chen

et al. 2023

Medicine

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This study aimed to develop a noninvasive predictive model for identifying early postoperative recurrence of hepatocellular carcinoma (within 2 years after surgery) based on contrast-enhanced ultrasound and serum biomarkers. Additionally, the model’s validity was assessedthrough internal and external validation. Clinical data were collected from patients who underwent liver resection at the First Hospital of Quanzhou and Mengchao Hepatobiliary Hospital. The data included general information, contrast-enhanced ultrasound parameters, Liver Imaging Reporting and Data System (LI-RADS) classification, and serum biomarkers. The data from Mengchao Hospital were divided into 2 groups, with a ratio of 6:4, to form the modeling and internal validation sets, respectively. On the other hand, the data from the First Hospital of Quanzhou served as the external validation group. The developed model was named the Hepatocellular Carcinoma Early Recurrence (HCC-ER) prediction model. The predictive efficiency of the HCC-ER model was compared with other established models. The baseline characteristics were found to be well-balanced across the modeling, internal validation, and external validation groups. Among the independent risk factors identified for early recurrence, LI-RADS classification, alpha-fetoprotein, and tumor maximum diameter exhibited hazard ratios of 1.352, 1.337, and 1.135 respectively. Regarding predictive accuracy, the HCC-ER, Tumour-Node-Metastasis, Barcelona Clinic Liver Cancer, and China Liver Cancer models demonstrated prediction errors of 0.196, 0.204, 0.201, and 0.200 in the modeling group; 0.215, 0.215, 0.218, and 0.212 in the internal validation group; 0.210, 0.215, 0.216, and 0.221 in the external validation group. Using the HCC-ER model, risk scores were calculated for all patients, and a cutoff value of 50 was selected. This cutoff effectively distinguished the high-risk recurrence group from the low-risk recurrence group in the modeling, internal validation, and external validation groups. However, the calibration curve of the predictive model slightly overestimated the risk of recurrence. The HCC-ER model developed in this study demonstrated high accuracy in predicting early recurrence within 2 years after hepatectomy. It provides valuable information for developing precise treatment strategies in clinical practice and holds considerable promise for further clinical implementation.

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Section: Introductionmentioning

confidence: 99%

Revolutionising hepatocellular carcinoma surveillance: Harnessing contrast-enhanced ultrasound and serological indicators for postoperative early recurrence prediction

Tu,

Feng,

Chen

et al. 2023

Medicine

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“…Compared with late recurrence, early recurrence after surgery mainly is associated with the aggressiveness of the primary tumor. Some factors representing tumor aggressiveness such as tumor size, tumor number, MVI, and low differentiation have been shown to correlate with early recurrence in many studies 26 . Preoperative biological markers (e.g., AFP and PIVKA‐II) were also demonstrated to be associated with early recurrence of HCC patients after hepatectomy 8,46 .…”

Section: Discussionmentioning

confidence: 98%

“…However, it is worth noting that the TPS model lacks the ability to stratify late recurrence of AFP‐negative HCC patients after liver resection. Late recurrence after surgery is usually regarded as the new development of tumors of multicentric origin, mainly associated with underlying liver diseases 26 . From this perspective, the inability of the TPS model to stratify for late recurrence seems to be expected.…”

Section: Discussionmentioning

confidence: 99%

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

Qiu,

Wu,

et al. 2023

Cancer Medicine

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BackgroundThis study aimed to establish a simple prognostic scoring model based on tumor burden score (TBS) and PIVKA‐II to predict long‐term outcomes of α‐fetoprotein (AFP)‐negative hepatocellular carcinoma (HCC) patients.Methods511 patients were divided into the training cohort (n = 305) and the validation cohort (n = 206) at a ratio of 6:4. Receiver operating characteristic curves (ROC) were established to identify cutoff values of TBS and PIVKA‐II. Kaplan–Meier curves were used to analyze survival outcomes. The multivariable Cox regression was used to identify variables independently associated with survival outcomes. The predictive performance of the TBS‐PIVKA II score (TPS) model was compared with Barcelona clinic liver cancer (BCLC) stage and American Joint Committee on Cancer (AJCC TNM) stage.ResultsThe present study established the TPS model using a simple scoring system (0, 1 for low/high TBS [cutoff value: 4.1]; 0, 1 for low/high PIVKA‐II [cutoff value: 239 mAU/mL]). The TPS scoring model was divided into three levels according to the summation of TBS score and PIVKA‐II score: TPS 0, TPS 1, and TPS 2. The TPS scoring model was able to stratify OS (training: p < 0.001, validation: p < 0.001) and early recurrence (training: p < 0.001; validation: p = 0.001) in the training cohort and the validation cohort. The TPS score was independently associated with OS (TPS 1 vs. 0, HR: 2.28, 95% CI: 1.01–5.17; TPS 2 vs. 0, HR: 4.21, 95% CI: 2.01–8.84) and early recurrence (TPS 1 vs. 0, HR: 3.50, 95% CI: 1.71–7.16; TPS 2 vs. 0, HR: 3.79, 95% CI: 1.86–7.75) in the training cohort. The TPS scoring model outperformed BCLC stage and AJCC TNM stage in predicting OS and early recurrence in the training cohort and the validation cohort. But the TPS scoring model was unable to stratify the late recurrence in the training cohort (p = 0.872) and the validation cohort (p = 0.458).ConclusionsThe TPS model outperformed the BCLC stage and AJCC TNM stage in predicting OS and early recurrence of AFP‐negative HCC patients after liver resection, which might better assist surgeons in screening AFP‐negative HCC patients who may benefit from liver resection.

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“…Primary liver cancer, particularly HCC, is a substantial public health problem and a leading cause of death globally (Ganesan and Kulik 2023 ; Forner et al 2018 ). At present, the high recurrence rate of HCC continues to affect patients' quality of life, emphasizing the importance of developing more accurate surveillance tests (Nevola et al 2023 ). Therefore, our retrospective cohort study included 390 HCC patients after local ablation and assessed the performance of GALAD score for forecasting the prognosis.…”

Section: Discussionmentioning

confidence: 99%

GALAD score as a prognostic model for recurrence of hepatocellular carcinoma after local ablation

Qiao,

Li,

Xiong

et al. 2024

J Cancer Res Clin Oncol

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Background Currently, the high recurrence rate still forms severe challenges in hepatocellular carcinoma (HCC) treatment. The GALAD score, including age, gender, alpha-fetoprotein (AFP), lens culinaris agglutinin-reactive AFP (AFP-L3), and des-gamma-carboxyprothrombin (DCP) was developed as a diagnostic model. However, evidence is still lacking to confirm the capability of the GALAD score to predict the recurrence of HCC. Methods This study included 390 HCC patients after local ablation at Beijing You'an Hospital from January 1, 2018, to December 31, 2022. Firstly, the area under the receiver operating characteristic (ROC) curve (AUC) was calculated to assess the predictive capability of the GALAD score. Then, the Kaplan–Meier (KM) curve and log-rank test were used to compare the prognosis between two groups classified by GALAD score. Finally, a nomogram for high-risk patients was established by Lasso-Cox regression. It was assessed by ROC curves, calibration curves, and decision curve analysis (DCA). Results The ROC curve (AUC: 0.749) and KM curve showed the GALAD score had good predictive ability and could clearly stratify patients into two groups through the risk of recurrence. Prognostic factors selected by Lasso-Cox regression contained tumor number, tumor size, and globulin. The nomogram for high-risk patients showed reliable discrimination, calibration, and clinical utility. Conclusion This research displayed that the GALAD score is an effective model for predicting the recurrence of HCC. Meanwhile, we found the poor prognosis of the high-risk group and created a nomogram for these patients.

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Predictors of early and late hepatocellular carcinoma recurrence

Cited by 51 publications

References 144 publications

Revolutionising hepatocellular carcinoma surveillance: Harnessing contrast-enhanced ultrasound and serological indicators for postoperative early recurrence prediction

Revolutionising hepatocellular carcinoma surveillance: Harnessing contrast-enhanced ultrasound and serological indicators for postoperative early recurrence prediction

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

GALAD score as a prognostic model for recurrence of hepatocellular carcinoma after local ablation

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