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Scoring system based on tumor markers and Child-Pugh classification for HCC patients who underwent liver resection
Shigeki Nakagawa1, Hiromitsu Hayashi1, Hidetoshi Nitta1
1Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan.
Insights
A new prognostic system, the tumor marker staging (TMS), aids in predicting hepatocellular carcinoma (HCC) recurrence and survival after surgery. This staging system better evaluates patient prognosis than relying solely on tumor markers.
Area of Science:
- Hepatocellular Carcinoma Research
- Oncology Prognostics
- Biomarker Discovery
Background:
- Hepatocellular carcinoma (HCC) patients undergoing hepatic resection (HR) face poor long-term prognoses due to impaired liver function and high recurrence rates.
- Existing prognostic models require enhancement for better patient stratification.
Purpose of the Study:
- To develop and validate a novel prognostic system for HCC patients after HR.
- To integrate tumor markers and liver function (Child-Pugh classification) for improved outcome prediction.
Main Methods:
- A cohort of 427 HCC patients was analyzed.
- Three key tumor markers—alpha-fetoprotein (AFP), AFP-L3, and des-gamma-carboxyprothrombin (DCP)—were assessed alongside Child-Pugh classification.
- The stepwise Cox regression model was employed to establish the tumor marker staging (TMS).
Main Results:
- The developed TMS categorizes patients into four stages (0/1/2/3).
- Five-year recurrence rates across TMS stages were 76.7%, 72.3%, 80.9%, and 100%, respectively.
- Five-year overall survival rates decreased across stages: 77.0%, 68.7%, 52.1%, and 28.9%.
Conclusions:
- The TMS demonstrates superior predictive accuracy for recurrence and survival post-hepatectomy compared to using only the count of positive tumor markers.
- TMS serves as a valuable tool for assessing the biological status and background liver function in HCC patients.
Background:
The long-term prognosis of hepatocellular carcinoma (HCC) patients after hepatic resection (HR) remains poor because of limited liver function and frequent recurrences. We created a prognostic system of HCC based on tumor markers and Child-Pugh classification.
Patients And Methods:
This study investigated 427 HCC patients and three tumor markers (alpha-fetoprotein (AFP), Lens culinaris agglutinin-reactive fraction of AFP (AFP-L3), des-γ -carboxyprothrombin (DCP)) in relation to Child-Pugh classification by the stepwise Cox regression model for establishing a tumor marker staging (TMS).
Results:
The TMS shows four levels (0/1/2/3) with 5-year recurrence rate of each stage of 76.7, 72.3, 80.9 and 100%, respectively, and 5-year overall survival of 77.0, 68.7, 52.1 and 28.9%, respectively. This TMS appears to be a better model to predict the recurrence and survival of HCC patients after hepatectomy than only the number of positive tumor markers.
Conclusion:
TMS is a useful staging system to evaluate biological status and background liver function.
