A Novel Score Predicts HBV-Related Hepatocellular Carcinoma Recurrence After Hepatectomy: a Retrospective Multicenter Study
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In China, hepatitis B virus (HBV) is an important causative factor of hepatocellular carcinoma (HCC). The contribution and interaction of fibrosis-4 (FIB-4) score and total tumor volume (TTV) in association with HCC recurrence is unknown. A reliable point score based on the FIB-4 score, TTV, and differentiation grade was established to predict the postoperative recurrence of HBV-related HCC patients who underwent hepatic resection (HR).
Three hundred thirty-eight HBV-related HCC patients from three institutions treated by HR were enrolled in this retrospective study. Prognostic factors were also evaluated by univariate and multivariate analysis using Cox’s proportional hazards model in the training cohort. The DFT score was established by a Cox regression model and validated in the internal cohort and the external cohorts from the other two institutions.
The DFT score differentiated four groups of HBV-related HCC patients (0, 1–2, 3, 4–5 points) with distinct prognosis (median recurrence-free survival (RFS), 72.7 vs. 53.0 vs. 23.2 vs. 5.7 months; P < 0.05). Its predictive accuracy as determined by the area under the receiver operating characteristic curve (AUC) at 1, 3, and 5 years (AUCs 0.7319, 0.7031, and 0.6972) was greater than the other three staging systems for HCC. These findings were supported by the validation cohorts.
The DFT model is a reliable and objective model to predict the RFS of HBV-related HCC patients after HR.
KeywordsHepatocellular carcinoma Hepatic resection Recurrence-free survival Total tumor volume FIB-4
This work was supported by the grants from the Project funded by China Postdoctoral Science Foundation (2017M611459), National Natural Science Foundation of China (No. 81370575, 81570593), Sci-tech Research Development Program of Guangzhou city (No. 1581000156, 201400000001-3), and Sun Yat-sen University Clinical Research 5010 Program (2014006).
Conception and design: Wei Qin, Guihua Chen, Yang Yang
Acquisition of data: Li Wang, Beiyuan Hu, Shusheng Leng, Huanxian Luo
Analysis and interpretation of data: Huan Tian, Jia Yao, Chao Wu
Writing, review, and/or revision of the manuscript: Wei Qin, Xiaolong Chen, Yang Yang
Compliance with Ethical Standards
This study was approved by the Ethics Committee of The Third Affiliated Hospital of Sun Yat-Sen University, Huashan Hospital, Fudan University, The Affiliated Hospital/Clinical Medical College of Chengdu University, and conducted in accordance with the Declaration of Helsinki. A written informed consent was obtained from all the patients at the time of admission.
Conflict of Interest
The authors declare that they have no conflict of interest.
- 1.Makuuchi M, Takayama T, Kubota K, Kimura W, Midorikawa Y, Miyagawa S, Kawasaki S. Hepatic resection for hepatocellular carcinoma—Japanese experience. Hepatogastroenterology. 1998; 45(Suppl 3): 1267–1274.Google Scholar
- 8.Kim WR, Berg T, Asselah T, Flisiak R, Fung S, Gordon SC, Janssen HL, Lampertico P, Lau D, Bornstein JD, Schall RE, Dinh P, Yee LJ, Martins EB, Lim SG, Loomba R, Petersen J, Buti M, Marcellin P. Evaluation of APRI and FIB-4 scoring systems for non-invasive assessment of hepatic fibrosis in chronic hepatitis B patients. J Hepatol. 2016; 64(4): 773–780.CrossRefGoogle Scholar
- 17.Imamura H, Matsuyama Y, Tanaka E, Ohkubo T, Hasegawa K, Miyagawa S, Sugawara Y, Minagawa M, Takayama T, Kawasaki S, Makuuchi M. Risk factors contributing to early and late phase intrahepatic recurrence of hepatocellular carcinoma after hepatectomy. J Hepatol. 2003; 38(2): 200–207.CrossRefGoogle Scholar
- 20.Andreou A, Vauthey JN, Cherqui D, Zimmitti G, Ribero D, Truty MJ, Wei SH, Curley SA, Laurent A, Poon RT, Belghiti J, Nagorney DM, Aloia TA. International Cooperative Study Group on Hepatocellular Carcinoma. Improved long-term survival after major resection for hepatocellular carcinoma: a multicenter analysis based on a new definition of major hepatectomy. J Gastrointest Surg. 2013; 17(1): 66–77.CrossRefGoogle Scholar
- 21.Cucchetti A, Piscaglia F, Caturelli E, Benvegnù L, Vivarelli M, Ercolani G, Cescon M, Ravaioli M, Grazi GL, Bolond L, Pinna AD. Comparison of recurrence of hepatocellular carcinoma after resection in patients with cirrhosis to its occurrence in a surveilled cirrhotic population. Ann Surg Oncol. 2009; 16(2): 413–422.CrossRefGoogle Scholar