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

Abstract

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