Abstract
Abstract
Background
Patients with Barcelona Clinic Liver Cancer stage B (BCLC-B) hepatocellular carcinoma (HCC) are characterized by heterogeneity in functional hepatic reserve and tumor burden. Conventional prognosis indexes are not specific to this stage. This study aimed to establish novel prognosis indexes that integrated functional hepatic reserve and tumor burden in patients with BCLC-B HCC.
Methods
A total of 1,843 patients with BCLC-B HCC were retrospectively enrolled from four hospitals. The primary endpoint was overall survival. Tumor burden was quantified as the biproduct or sum of the maximum diameter and the number of tumor nodules, that is referred to as mMDN and mUS. Functional hepatic reserve was described using the albumin-bilirubin (ALBI) score.
Results
Multivariate analysis demonstrated that functional hepatic reserve and tumor burden were significantly associated with overall survival. Novel prognosis indexes, termed mMDN/ALBI and mUS/ALBI, were generated by dividing mMDN and mUS by the absolute value of the ALBI score. The mMDN/ALBI and mUS/ALBI models demonstrated superior prognostic stratification of overall survival compared with the ALBI and Tokyo scores, as reflected by higher log-rank trend chi-square statistics and C-index values. Time-dependent ROC and decision curve analyses further supported their superior predictive performance and clinical utility. mMDN/ALBI≥8.2 indicated poor overall survival with a median survival time of 12 to 14 months whether functional hepatic reserve was preserved or not. mUS/ALBI≥5.6 also suggested the median survival time of 9 to 12 months.
Conclusion
The novel prognosis indexes stratified overall survival more clearly compared to the ALBI score and Tokyo score. These indexes enable more accurate prognosis prediction for patients with BCLC-B HCC.