[en] [en] BACKGROUND: Surgical resection (SR) is a potentially curative treatment of hepatocellular carcinoma (HCC) hampered by high rates of recurrence. New drugs are tested in the adjuvant setting, but standardised risk stratification tools of HCC recurrence are lacking.
OBJECTIVES: To develop and validate a simple scoring system to predict 2-year recurrence after SR for HCC.
METHODS: 2359 treatment-naïve patients who underwent SR for HCC in 17 centres in Europe and Asia between 2004 and 2017 were divided into a development (DS; n = 1558) and validation set (VS; n = 801) by random sampling of participating centres. The Early Recurrence Score (ERS) was generated using variables associated with 2-year recurrence in the DS and validated in the VS.
RESULTS: Variables associated with 2-year recurrence in the DS were (with associated points) alpha-fetoprotein (<10 ng/mL:0; 10-100: 2; >100: 3), size of largest nodule (≥40 mm: 1), multifocality (yes: 2), satellite nodules (yes: 2), vascular invasion (yes: 1) and surgical margin (positive R1: 2). The sum of points provided a score ranging from 0 to 11, allowing stratification into four levels of 2-year recurrence risk (Wolbers' C-indices 66.8% DS and 68.4% VS), with excellent calibration according to risk categories. Wolber's and Harrell's C-indices apparent values were systematically higher for ERS when compared to Early Recurrence After Surgery for Liver tumour post-operative model to predict time to early recurrence or recurrence-free survival.
CONCLUSIONS: ERS is a user-friendly staging system identifying four levels of early recurrence risk after SR and a robust tool to design personalised surveillance strategies and adjuvant therapy trials.
Disciplines :
Surgery Oncology Gastroenterology & hepatology
Author, co-author :
Costentin, Charlotte ; Grenoble Alpes University, Institute for Advanced Biosciences, Research Center UGA/Inserm U 1209/CNRS 5309, Gastroenterology, Hepatology and GI Oncology Department, Digidune, Grenoble Alpes University Hospital, La Tronche, France
Audureau, Etienne; Service de Santé Publique, Assistance Publique Hôpitaux de Paris, Hôpital Henri Mondor, and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, Créteil, France
Park, Young Nyun ; Department of Pathology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, Republic of Korea
Langella, Serena; Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Turin, Italy
Vibert, Eric; Centre hépato-biliaire, Assistance Publique Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
Laurent, Alexis; Service de Chirurgie Digestive, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Créteil, France
Cauchy, François; Service de Chirurgie Hepato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Beaujon, AP-HP et Université de Paris, Clichy, France
Scatton, Olivier; Service de Chirurgie Digestive, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié Salpétrière, Paris, France
Chirica, Mircea; Service de Chirurgie Digestive, CHU Grenoble-Alpes, Grenoble, France
Rhaiem, Rami; Service de Chirurgie Digestive, CHU de Reims, Reims, France
Boleslawski, Emmanuel; Univ. Lille, INSERM U1189, CHU Lille, Service de Chirurgie Digestive et Transplantations, Lille, France
di Tommaso, Luca; Unit of Pathology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy ; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
Ferrero, Alessandro; Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Turin, Italy
Yano, Hirohisa; Department of Pathology, Kurume University School of Medicine, Kurume, Japan
Akiba, Jun; Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
Donadon, Matteo; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy ; Department of Hepatobiliary and General Surgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
Nebbia, Martina; Department of Surgery, Colon and Rectal Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
Detry, Olivier ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chirurgie abdo, sénologique, endocrine et de transplantation
Honoré, Pierre ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chirurgie abdo, sénologique, endocrine et de transplantation
Di Martino, Marcello; Department of Surgery, HPB Unit, University Hospital La Princesa, Madrid, Spain
Schwarz, Lilian; Service de Chirurgie Digestive, CHU de Rouen, Rouen, France
Barbier, Louise ; Service de Chirurgie Digestive, CHU de Tours, Tours, France
Nault, Jean-Charles ; Liver Unit, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Bobigny, France ; Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris, team « Functional Genomics of Solid Tumors », Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, Paris, France
Rhee, Hyungjin; Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
Lim, Chetana; Service de Chirurgie Digestive, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié Salpétrière, Paris, France
Brustia, Raffaele; Service de Chirurgie Digestive, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Créteil, France
Paradis, Valérie ; Service d'Anatomie et de Cytologie Pathologique, Assistance Publique Hôpitaux de Paris, Hôpital Beaujon, Université de Paris, Clichy, France
Guettier, Catherine; Service d'Anatomie et de Cytologie Pathologique, Assistance Publique Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
Le Bail, Brigitte; Service de Pathologie, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
Okumura, Shinya; Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Blanc, Jean-Frédéric; Service Hépato-Gastroentérologie et Oncologie Digestive, Centre Médico-Chirurgical Magellan, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
Calderaro, Julien; Département de Pathologie, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Créteil, France
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