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A Prognostic Model To Predict Survival After Recurrence Among Patients With Recurrent Hepatocellular Carcinoma.
Moazzam, Zorays; Alaimo, Laura; Endo, Yutaka; Lima, Henrique A; Woldesenbet, Selamawit; Rueda, Belisario Ortiz; Yang, Jason; Ratti, Francesca; Marques, Hugo P; Cauchy, Francois; Lam, Vincent; Poultsides, George A; Popescu, Irinel; Alexandrescu, Sorin; Martel, Guillaume; Guglielmi, Alfredo; Hugh, Tom; Aldrighetti, Luca; Shen, Feng; Endo, Itaru; Pawlik, Timothy M.
Afiliação
  • Moazzam Z; Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
  • Alaimo L; Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
  • Endo Y; Department of Surgery, University of Verona, Verona, Italy.
  • Lima HA; Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
  • Woldesenbet S; Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
  • Rueda BO; Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
  • Yang J; Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
  • Ratti F; Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
  • Marques HP; Department of Surgery, Ospedale San Raffaele, Milan, Italy.
  • Cauchy F; Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal.
  • Lam V; Department of Hepatobiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France.
  • Poultsides GA; Department of Surgery, Westmead Hospital, Sydney, NSW, Australia.
  • Popescu I; Department of Surgery, Stanford University, Stanford, CA.
  • Alexandrescu S; Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania.
  • Martel G; Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania.
  • Guglielmi A; Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
  • Hugh T; Department of Surgery, University of Verona, Verona, Italy.
  • Aldrighetti L; Department of Surgery, School of Medicine, The University of Sydney, Sydney, NSW, Australia.
  • Shen F; Department of Surgery, Ospedale San Raffaele, Milan, Italy.
  • Endo I; The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
  • Pawlik TM; Yokohama City University School of Medicine, Yokohama, Japan.
Ann Surg ; 279(3): 471-478, 2024 Mar 01.
Article em En | MEDLINE | ID: mdl-37522251
ABSTRACT

OBJECTIVE:

We sought to develop and validate a preoperative model to predict survival after recurrence (SAR) in hepatocellular carcinoma (HCC).

BACKGROUND:

Although HCC is characterized by recurrence as high as 60%, models to predict outcomes after recurrence remain relatively unexplored.

METHODS:

Patients who developed recurrent HCC between 2000 and 2020 were identified from an international multi-institutional database. Clinicopathologic data on primary disease and laboratory and radiologic imaging data on recurrent disease were collected. Multivariable Cox regression analysis and internal bootstrap validation (5000 repetitions) were used to develop and validate the SARScore. Optimal Survival Tree analysis was used to characterize SAR among patients treated with various treatment modalities.

RESULTS:

Among 497 patients who developed recurrent HCC, median SAR was 41.2 months (95% CI 38.1-52.0). The presence of cirrhosis, number of primary tumors, primary macrovascular invasion, primary R1 resection margin, AFP>400 ng/mL on the diagnosis of recurrent disease, radiologic extrahepatic recurrence, radiologic size and number of recurrent lesions, radiologic recurrent bilobar disease, and early recurrence (≤24 months) were included in the model. The SARScore successfully stratified 1-, 3- and 5-year SAR and demonstrated strong discriminatory ability (3-year AUC 0.75, 95% CI 0.70-0.79). While a subset of patients benefitted from resection/ablation, Optimal Survival Tree analysis revealed that patients with high SARScore disease had the worst outcomes (5-year AUC; training 0.79 vs. testing 0.71). The SARScore model was made available online for ease of use and clinical applicability ( https//yutaka-endo.shinyapps.io/SARScore/ ).

CONCLUSION:

The SARScore demonstrated strong discriminatory ability and may be a clinically useful tool to help stratify risk and guide treatment for patients with recurrent HCC.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Carcinoma Hepatocelular / Neoplasias Hepáticas Tipo de estudo: Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: Ann Surg Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Carcinoma Hepatocelular / Neoplasias Hepáticas Tipo de estudo: Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: Ann Surg Ano de publicação: 2024 Tipo de documento: Article