Tumor Burden Score Stratifies Prognosis of Patients With Intrahepatic Cholangiocarcinoma After Hepatic Resection: A Retrospective, Multi-Institutional Study

Abstract

BackgroundThe prognostic significance of tumor burden score (TBS) on patients who underwent curative-intent resection of intrahepatic cholangiocarcinoma (ICC) has not been evaluated. The present study aimed to investigate the impact of TBS and its synergistic effect with CA19-9 (combination of TBS and CA19-9, CTC grade) on long-term outcomes.MethodsPatients who underwent radical resection of ICC between 2009 and 2017 were retrospectively identified from a multi-center database. The overall survival (OS) and recurrence-free survival (RFS) were examined in relation to TBS, serum preoperative CA19-9, and CTC grade.ResultsA total of 650 patients were included in our study (509 in the derivation cohort and 141 in the validation cohort). Kaplan–Meier curves showed that both TBS and CA19-9 levels were strong predictors of survival outcomes. Patients with elevated TBS grade or elevated CA19-9 were associated with worse OS and RFS (both p < 0.001). As expected, CTC grade also performed well in predicting long-term outcomes. Patients with low TBS/low CA19-9 (CTC grade 1) were associated with the best OS as well as RFS, while high TBS/high CA19-9 (CTC grade 3) correlated to the worst outcomes. In the validation cohort, TBS grade, preoperative CA19-9, and CTC grade also stratified prognosis among patients (p < 0.001 for each).ConclusionsBoth tumor morphology (tumor burden) and tumor-specific biomarker (serum CA19-9) were important when evaluating prognosis of patients with resectable ICC. Serum CA19-9 and TBS showed a synergistic effect on prognostic evaluation. CTC grade was a promising tool in stratifying prognosis of ICC patients after curative resection.

Tumor burden score dictates prognosis of patients with combined hepatocellular cholangiocarcinoma undergoing hepatectomy

“…TBS was defined as the distance from the origin of a Cartesian plane using maximum tumor size as the X-axis and tumor number as the Y-axis (9). As previously reported, TBS is a valuable tool in evaluating prognosis for colorectal liver metastases, HCC, and ICC (13,26,27). The present study assessed the significance of TBS in dictating the prognosis of patients with cHCC-CCA after curative liver resection.…”

“…Recently, a new metric called "tumor burden score (TBS)", calculated on the basis of tumor size and tumor number, was proposed for risk stratification in multifocal tumors (9). Emerging evidence has shown the promising potential of TBS in stratifying the prognosis of patients with colorectal liver metastasis, HCC, and ICC who underwent surgical resection (10)(11)(12)(13). Nevertheless, the prognostic value of TBS in patients with cHCC-CCA has not been evaluated.…”

Is tumor necrosis a clinical prognostic factor in hepato‐biliary‐pancreatic cancers? A systematic review and meta‐analysis

“…Several pathological features such as, tumor burden, tumor histological differentiation/ grade, lymph node metastasis, and vascular and neural invasion, have remained predictors of outcomes in HBP cancer patients. [9][10][11][12][13] Some of these histopathological parameters are included in the American Joint Committee on Cancer eighth edition TNM staging system to predict the prognoses of HBP cancer patients. [14][15][16] However, clinical outcomes may vary significantly among patients at the same pathological stage, which indicates that there exist other factors which may also impact the prognoses.…”

A novel model for predicting the prognosis of postoperative intrahepatic cholangiocarcinoma patients

“…However, the practical clinical application of these biomarkers remains limited. [4][5][6] . In order to predict the prognosis of ICC patients, it is important to identify a biomarker that has both high value and convenient application in clinical practice.…”