Researchers have developed a personalized calculator that may be capable of predicting the reduced risk of early recurrence in patients with hepatocellular carcinoma, according to a recent study published by Chen et al in eGastroenterology.
Background
Hepatocellular carcinoma is the most common type of hepatic cancer and the fourth leading cause of cancer-related mortality worldwide—with China accounting for more than 50% of the global annual incidence and mortality.
Although hepatectomy is the standard curative-intent treatment option for appropriately selected patients with localized hepatocellular carcinoma, the high postoperative recurrence rate results in poor prognoses and high incidences of cancer-specific mortality in this patient population. This occurs in especially early recurrence within 1 year after surgery, which is most likely caused by occult micrometastases from the original tumor. Given that survival among patients with recurrence is significantly worse than those without recurrence, there has been considerable interest in various neoadjuvant and adjuvant treatment approaches to prevent early recurrence in patients who have undergone hepatectomy.
Transarterial chemoembolization (TACE)—an adjuvant treatment performed 4 to 8 weeks after hepatectomy—is designed to reduce the risk of postoperative recurrence and improve long-term prognosis by eliminating occult micrometastases related to the original tumor or residual tumors left after surgery. However, adjuvant TACE’s impact in preventing postsurgical recurrence remains controversial. Several previous studies reported no benefit or decreased survival using adjuvant TACE, potentially related to poor selection criteria. But a recent comprehensive review of adjuvant TACE suggested patients at high risk of recurrence may benefit from the treatment option.
Study Methods and Results
In this study, the researchers developed an Internet browser–based decision calculator to help physicians make decisions regarding adjuvant TACE after hepatectomy, identify patients at high risk of early recurrence after curative hepatectomy, and estimate the degree of early recurrence risk reduction based on adjuvant use of TACE at the individual patient level. The risk prediction model was based on eight independent factors and demonstrated good discrimination and calibration, with C-indices greater than 0.75 in training and validation cohorts.
The researchers noted that adjuvant TACE may be more suitable for patients likely to develop early recurrence after hepatectomy. Recent randomized control studies and systematic reviews have indicated thatthe treatment option was associated with improved long-term survival only in subsets of patients with one or more high-risk characteristics of hepatocellular carcinoma recurrence but not in patients with no high-risk features.
Based on the results from the calculator, the investigators noted, patients could be stratified into risk groups relative to early recurrence, which could also categorize their risk of cancer-specific survival.
Conclusions
The researchers suggested that predicting individual patient risk of developing postoperative recurrence may be significant when deciding whether to use adjuvant TACE for this patient population.
The new personalized calculator is one of the first prediction models to estimate the reduced risk of early cancer recurrence. The researchers hope their new findings may help physicians decide whether patients undergoing hepatectomy for hepatocellular carcinoma could benefit from adjuvant TACE.
Disclosure: For full disclosures of the study authors, visit egastroenterology.bmj.com.
