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BALAD score predicts the recurrence and survival in the patients who underwent initial hepatectomy for HCC
Shigeki Nakagawa1, Hiromitsu Hayashi1, Rumi Itoyama1
1Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-0811, Japan.
Insights
The BALAD score, incorporating HCC tumor markers and liver function tests, predicts poor outcomes for liver cancer patients undergoing curative surgery. Higher scores indicate increased recurrence and reduced overall survival.
Area of Science:
- Hepatocellular Carcinoma Research
- Surgical Oncology
- Biomarker Development
Background:
- The BALAD score, a composite index of HCC tumor markers (AFP, AFP-L3%, DCP) and serum albumin/bilirubin, is recognized for predicting outcomes in HCC patients across various treatments.
- Previous studies suggest the BALAD score's prognostic value, but its specific impact after curative surgical resection requires further clarification.
Purpose of the Study:
- To evaluate the prognostic significance of the BALAD score in patients who have undergone curative liver resection for hepatocellular carcinoma (HCC).
- To determine the association between BALAD score levels and post-operative recurrence rates and overall survival in HCC patients.
Main Methods:
- A retrospective analysis of 578 patients who underwent hepatectomy for HCC between January 2003 and May 2013.
- Patients were stratified based on their BALAD score, and cumulative recurrence rates, overall survival (OS), and clinicopathological parameters were analyzed.
Main Results:
- Higher BALAD scores were significantly correlated with increased recurrence rates (p=0.0015) and poorer overall survival (p<0.0001).
- Multivariate analysis identified male gender, HCV-antibody positivity, multiple tumors, microvascular invasion, and a higher BALAD score as independent risk factors for recurrence.
- Independent predictors for OS included multiple tumors, microvascular invasion, and a higher BALAD score.
Conclusions:
- The BALAD score serves as a significant prognostic indicator for patients undergoing curative liver resection for HCC.
- Elevated BALAD scores are associated with a higher likelihood of recurrence and diminished overall survival following surgical treatment for HCC.
Backgrounds:
Several studies have indicated that BALAD score which includes the HCC tumor markers of HCC, AFP, AFP-L3%, DCP, and serum albumin and bilirubin value were good predictors of HCC patients for all treatment modalities. In this study, we aim to clarify the impact of BALAD score as the prognostic factor for HCC patients after curative surgery.
Methods:
This study investigated 578 patients who underwent hepatectomy for HCC between January 2003 and May 2013. Cumulative recurrence rate, overall survival (OS), and clinicopathological parameters were analyzed according to the level of BALAD score.
Results:
In patients with higher BALAD score, recurrence rate and OS was poor (p = 0.0015 and p < 0.0001, respectively). Multivariate analyses revealed independent risk factors for recurrence to be male (hazard ratio [HR] 1.52, P = 0.011), HCV-antibody positive (HR 1.33, P = 0.019), multiple tumors (HR 2.16, P < 0.0001), microvascular invasion (HR 1.45, P = 0.0035) and higher BALAD score (RR 1.70, P = 0.015). The independent risk factors for OS were multiple tumors (HR 1.52, P = 0.014), microvascular invasion (HR 1.53, P = 0.012), and higher BALAD score (RR 2.51, P = 0.0012).
Conclusion:
BALAD score is associated with high recurrence rate and poor overall survival of the patients who underwent curative liver resection for HCC.
