Hepatocellular carcinoma (HCC) is probably the most commonly diagnosed cancer of the liver and the fourth leading reason behind cancer-related mortality worldwide, with China accounting for over half of the worldwide annual cases and deaths. Hepatectomy is the usual curative-intent treatment option for appropriately chosen patients with localized HCC. Nevertheless, the high postoperative reoccurrence rate causes many patients to have a poor prognosis and a high incidence of cancer-specific death. This happens in especially early reoccurrence inside the first yr after surgery, which is most certainly as a consequence of occult micro-metastasis from the unique tumor. On condition that survival amongst patients with reoccurrence is markedly worse than those without, there was considerable interest in various neoadjuvant and adjuvant treatment approaches to forestall early reoccurrence following hepatectomy.

In a recent paper published in eGastroenterology, a team of scientists led by Professor Tian Yang from Eastern Hepatobiliary Surgery Hospital and Professor Jian-Song Ji from Lishui Hospital developed a personalised calculator could be used as a predictive tool for estimating the reduced risk of early reoccurrence in HCC patients.

No treatment modalities have been widely adopted, and international guidelines recommend none. Identifying specific subsets of HCC patients who’re at the very best risk of reoccurrence and who might preferentially profit from adjuvant treatment to cut back reoccurrence, particularly for early reoccurrence inside a brief period after surgery, has been a subject of interest.

Transarterial chemoembolization (TACE) performed 4-8 weeks after hepatectomy is an adjuvant treatment used to cut back risks of postoperative reoccurrence and improve long-term prognosis. In theory, adjuvant TACE can eliminate occult micro-metastasis related to the unique tumor, or residual tumors left after surgery, thereby stopping early reoccurrence after surgery.

Adjuvant TACE’s impact in stopping post-hepatectomy reoccurrence stays controversial. Several single-center randomized controlled trials (RCTs) reported no profit or decreased survival using adjuvant TACE. These disappointing results could also be related to poor selection criteria. Only a recent comprehensive review on adjuvant TACE suggested that patients at high risk of reoccurrence benefited from adjuvant TACE.

There was increasing interest in the event of cancer risk prediction models. These models could be helpful decision-making tools in clinical settings. Such tools could also be more reliable than a private clinical judgment about whether a person may profit from adjuvant therapy.

The research team sought to develop a prediction tool to discover HCC patients at high risk of early reoccurrence after curative hepatectomy. Additionally they aimed to estimate the degree of risk reduction for early reoccurrence based on adjuvant TACE utilization at the person patient level. The team developed an Web browser-based decision calculator to assist clinicians make decisions about adjuvant TACE after hepatectomy for HCC.

Postoperative adjuvant therapies predominantly eliminate a microvascular disease originating from the first tumor or residual foci left after resection for malignant tumors. Adjuvant TACE could also be more suitable for patients prone to develop early reoccurrence after hepatectomy for HCC. Recent randomized control studies (RCTs) and systematic reviews have indicated that adjuvant TACE was related to improved long-term survival only in subsets of patients with a number of high-risk characteristics of HCC reoccurrence but not for patients with no high-risk features. Due to this fact, predicting individual patient risk of developing postoperative reoccurrence is of great importance in deciding whether to make use of adjuvant TACE for patients with HCC.

The study aimed to discover the personalized net profit by reducing the chance of early reoccurrence related to adjuvant TACE for a person patient undergoing hepatectomy for HCC using a prediction model based on eight independent aspects. The model demonstrated good discrimination and calibration, with C-indices greater than 0.75 in training and validation cohorts.

Based on this nomogram formula, a proposed online calculator was created to estimate the possibilities of early reoccurrence for HCC patients relative to receipt of adjuvant TACE. The difference between the 2 estimates being the expected profit from adjuvant TACE. Based on the calculator, patients could possibly be stratified into risk groups relative to early reoccurrence, which could also categorize the patient risk of CSS.

This model is the primary prediction model to estimate the reduced risk of early reoccurrence from adjuvant TACE amongst individual patients undergoing hepatectomy for HCC. These data may help clinicians in decision-making in regards to the potential role of adjuvant TACE amongst patients undergoing hepatectomy for HCC.

Source:

First Hospital of Jilin University

Journal reference:

Chen, W-Y., et al. (2023) Novel online calculator to predict reduced risk of early reoccurrence from adjuvant transarterial chemoembolisation for patients with hepatocellular carcinoma. eGastroenterology. doi.org/10.1136/egastro-2023-100008.