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Updated: Oct 26, 2025
The Influence of Liver Resection on Intrahepatic Tumor Growth
Published on: April 9, 2016
Impact of Tumor Burden Score on Conditional Survival after Curative-Intent Resection for Hepatocellular Carcinoma: A
Ahmed N Elfadaly1, Diamantis I Tsilimigras1, J Madison Hyer1
1Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Insights
Tumor burden score (TBS) impacts overall survival in hepatocellular carcinoma (HCC) patients after resection. However, conditional survival (CS) increases over time, regardless of TBS, offering dynamic prognostic insights.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Cancer survival analysis
Background:
- Tumor burden score (TBS) is a prognostic factor in hepatocellular carcinoma (HCC).
- The impact of TBS on conditional survival (CS) after curative-intent resection of HCC remains unexamined.
- Understanding factors influencing long-term survival post-HCC resection is crucial.
Purpose of the Study:
- To investigate the association between tumor burden score (TBS) and conditional survival (CS) in patients undergoing curative-intent liver resection for HCC.
- To evaluate how clinicopathologic factors, including TBS, influence 3-year conditional survival (CS3) after HCC resection.
- To assess the dynamic changes in survival probability over time post-HCC resection.
Main Methods:
- Retrospective analysis of 1,040 patients who underwent liver resection for HCC (2000-2017) from a multi-institutional database.
- Assessment of tumor burden score (TBS) and other clinicopathologic factors.
- Examination of the impact of TBS on overall survival (OS) and 3-year conditional survival (CS3).
Main Results:
- High TBS was significantly associated with decreased 5-year overall survival (OS) (39.0%) compared to medium (61.1%) and low TBS (79.4%).
- Conditional survival (CS) increased over time irrespective of TBS, indicating improving survival probability with elapsed time post-resection.
- The prognostic impact of adverse factors, including high TBS, diminished over time.
Conclusions:
- Conditional survival (CS) rates for HCC resection patients increase with time, irrespective of tumor burden score (TBS).
- CS estimates provide valuable dynamic prognostic information for patients after HCC resection.
- The influence of adverse prognostic factors wanes as patients survive longer post-operatively.
Background:
The impact of tumor burden score (TBS) on conditional survival (CS) among patients undergoing curative-intent resection of hepatocellular carcinoma (HCC) has not been examined to date.
Methods:
Patients who underwent liver resection of HCC between 2000 and 2017 were identified from a multi-institutional database. The impact of TBS and other clinicopathologic factors on 3-year conditional survival (CS3) was examined.
Results:
Among 1,040 patients, 263 (25.3%) patients had low TBS, 668 (64.2%) had medium TBS and 109 (10.5%) had high TBS. TBS was strongly associated with OS; 5-year OS was 39.0% among patients with high TBS compared with 61.1% and 79.4% among patients with medium and low TBS, respectively (p < 0.001). While actuarial survival decreased as time elapsed from resection, CS increased over time irrespective of TBS. The largest differences between 3-year actuarial survival and CS3 were noted among patients with high TBS (5-years postoperatively; CS3: 78.7% vs. 3-year actuarial survival: 30.7%). The effect of adverse clinicopathologic factors including high TBS, poor/undifferentiated tumor grade, microvascular invasion, liver capsule involvement, and positive margins on prognosis decreased over time.
Conclusions:
CS rates among patients who underwent resection for HCC increased as patients survived additional years, irrespective of TBS. CS estimates can be used to provide important dynamic information relative to the changing survival probability after resection of HCC.
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