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A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma
Published on: September 30, 2021
Adding nutritional status to the original BCLC stage improves mortality prediction for hepatocellular carcinoma
Yan-Ting Lin1, Po-Ting Lin1,2, Chen-Chun Lin1,2
1Division of Hepatology, Department of Gastroenterology and Hepatology, Chang-Gung Memorial Hospital, Linkou Medical Center Taoyuan, Taiwan.
Insights
A new model combining Barcelona Clinic Liver Cancer (BCLC) stage, hemoglobin (Hb), and albumin improves short-term mortality prediction for hepatocellular carcinoma (HCC) patients, highlighting nutrition
Area of Science:
- Hepatology and Oncology
- Clinical Prognostics
- Biomarker Research
Background:
- Hepatocellular carcinoma (HCC) presents a significant mortality challenge, particularly in regions with high chronic hepatitis B virus (HBV) infection rates.
- Accurate prognostic tools are crucial for effective clinical decision-making in HCC management.
- Existing models like Barcelona Clinic Liver Cancer (BCLC) stage, neutrophil-to-lymphocyte ratio (NLR), and Albumin-Bilirubin (ALBI) score have limitations in predicting short-term mortality.
Purpose of the Study:
- To compare the predictive accuracy of BCLC stage, NLR, and ALBI score for one- and two-year mortality in HCC patients.
- To develop and validate a novel prognostic model with enhanced accuracy for short-term mortality prediction in HCC.
- To investigate the role of nutritional markers, such as hemoglobin and albumin, in HCC prognosis.
Main Methods:
- A cohort of 298 HCC patients was analyzed to assess prognostic values using area under the receiver operating characteristic curve (AUROC).
- A novel prognostic model was developed incorporating BCLC stage, hemoglobin (Hb), and serum albumin levels.
- The novel model underwent internal validation using 5-fold cross-validation and external validation in a separate cohort of 100 patients.
Main Results:
- The Barcelona Clinic Liver Cancer (BCLC) classification demonstrated superior predictive accuracy for mortality compared to NLR, with borderline superiority over the ALBI score.
- Significant differences in hemoglobin and serum albumin levels were observed between surviving and non-surviving patients, indicating the importance of nutritional status.
- The novel "BCLC-Nutrition Model" achieved higher predictive accuracy for one- and two-year mortality (AUROC 0.841 and 0.805, respectively) compared to conventional models.
Conclusions:
- The novel "BCLC-Nutrition Model" incorporating BCLC stage, hemoglobin, and serum albumin offers improved predictive accuracy for short-term mortality in HCC patients.
- Nutritional status, reflected by hemoglobin and albumin levels, plays a critical role in the prognosis of HCC.
- This model provides a more precise tool for clinical decision-making and patient management in HCC, emphasizing nutritional support.
Abstract:
Hepatocellular carcinoma (HCC) is associated with high mortality, especially in Asian populations where chronic HBV infection is a major cause. Accurate prediction of mortality can assist clinical decision-making. We aim to (i) compare the predicting ability of Barcelona Clinic Liver Cancer classification (BCLC) stage, neutrophil-to-lymphocyte ratio (NLR), and Albumin-Bilirubin (ALBI) score in predicting short-term mortality (one- and two-year) and (ii) develop a novel model with improved accuracy compared to the conventional models. This study enrolled 298 consecutive HCC patients from our hepatology department. The prognostic values for mortality were assessed by area under the receiver operating characteristic curve (AUROC) analysis. A novel model was established and internally validated using 5-fold cross-validation, followed by external validation in a cohort of 100 patients. The primary etiology of cirrhosis was hepatitis B virus (HBV), with 81.2% of HCC patients having preserved liver function. Significant differences were observed in hemoglobin (Hb) and serum albumin levels, which reflect patients' nutrition status, between patients who survived for one year and those who died. BCLC exhibited superior predictive accuracy compared to NLR but had borderline superiority to the ALBI score. Therefore, a novel model incorporating BCLC, Hb, and serum albumin was developed, internally and externally validated, as well as subgroup sensitivity analysis. The model exhibited significantly higher predictive accuracy for one- and two-year mortality than conventional prognostic predictors, with AUROC values of 0.841 and 0.805, respectively. The novel "BCLC-Nutrition Model", which incorporates BCLC, Hb, and serum albumin, may provide improved predictive accuracy for short-term mortality in HCC patients compared to commonly used prognostic scores. This emphasizes the importance of nutrition in the management of HCC patients.
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