Predicting long-term survival among patients with HCC.

Area of Science:

• Hepatocellular Carcinoma Research
• Clinical Prognostics
• Liver Disease Survival Analysis

Background:

• Accurate prognostication for HCC and cirrhosis requires assessing tumor burden and liver disease severity.
• Existing staging systems are not widely adopted for predicting patient-level survival post-HCC diagnosis.
• Need for a predictive score using objective criteria for early- to intermediate-stage HCC.

Purpose of the Study:

• Develop a novel risk score to predict long-term survival in HCC patients.
• Utilize purely objective clinical, laboratory, and tumor data.
• Compare the score's performance against established staging systems.

Main Methods:

• Retrospective cohort study of 1325 HCC patients within the Veterans Health Administration (2014-2023).
• Manual abstraction of tumor data combined with clinical and laboratory data.
• Accelerated failure time models used for 5-year survival prediction; data split for training (75%) and validation (25%).

Main Results:

• The developed risk score demonstrated excellent discrimination (AUC: 0.71 in validation set) and calibration.
• The score outperformed the Barcelona Clinic Liver Cancer (BCLC) and Albumin-Bilirubin (ALBI) scores.
• Performance was comparable to the combined BCLC-ALBI score.

Conclusions:

• A risk score using objective data was developed to accurately predict long-term HCC survival.
• This score can aid in patient prognostication and inform liver transplantation candidacy.
• Potential to guide therapeutic decisions by quantifying net survival benefit.