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Utilizing Machine Learning for Pre- and Postoperative Assessment of Patients Undergoing Resection for BCLC-0, A and B Hepatocellular Carcinoma: Implications for Resection Beyond the BCLC Guidelines

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

There is an ongoing debate about expanding the resection criteria for hepatocellular carcinoma (HCC) beyond the Barcelona Clinic Liver Cancer (BCLC) guidelines. We sought to determine the factors that held the most prognostic weight in the pre- and postoperative setting for each BCLC stage by applying a machine learning method.

Methods

Patients who underwent resection for BCLC-0, A and B HCC between 2000 and 2017 were identified from an international multi-institutional database. A Classification and Regression Tree (CART) model was used to generate homogeneous groups of patients relative to overall survival (OS) based on pre- and postoperative factors.

Results

Among 976 patients, 63 (6.5%) had BCLC-0, 745 (76.3%) had BCLC-A, and 168 (17.2%) had BCLC-B HCC. Five-year OS among BCLC-0/A and BCLC-B patients was 64.2% versus 50.2%, respectively (p = 0.011). The preoperative CART model selected α-fetoprotein (AFP) and Charlson comorbidity score (CCS) as the first and second most important preoperative factors of OS among BCLC-0/A patients, whereas radiologic tumor burden score (TBS) was the best predictor of OS among BCLC-B patients. The postoperative CART model revealed lymphovascular invasion as the best postoperative predictor of OS among BCLC-0/A patients, whereas TBS remained the best predictor of long-term outcomes among BCLC-B patients in the postoperative setting. On multivariable analysis, pathologic TBS independently predicted worse OS among BCLC-0/A (hazard ratio [HR] 1.04, 95% confidence interval [CI] 1.02–1.07) and BCLC-B patients (HR 1.13, 95% CI 1.06–1.19) undergoing resection.

Conclusion

Prognostic stratification of patients undergoing resection for HCC within and beyond the BCLC resection criteria should include assessment of AFP and comorbidities for BCLC-0/A patients, as well as tumor burden for BCLC-B patients.

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Acknowledgement

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Funding

No sources of funding were used to assist in the preparation of this study.

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Authors and Affiliations

  1. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Diamantis I. Tsilimigras MD, Rittal Mehta MPH, Dimitrios Moris MD, PhD, Kota Sahara MD, Fabio Bagante MD, Anghela Z. Paredes MD, MS, Ayesha Farooq MD & Timothy M. Pawlik MD, MPH, PhD, FACS, FRACS (Hon.)

  2. Department of Surgery, University of Verona, Verona, Italy

    Fabio Bagante MD & Alfredo Guglielmi MD

  3. Department of Surgery, Ospedale San Raffaele, Milan, Italy

    Francesca Ratti MD & Luca Aldrighetti MD

  4. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal

    Hugo P. Marques MD & Silvia Silva MD

  5. Department of Hepatobiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France

    Olivier Soubrane MD

  6. Department of Surgery, Westmead Hospital, Sydney, NSW, Australia

    Vincent Lam MD

  7. Department of Surgery, Stanford University, Stanford, CA, USA

    George A. Poultsides MD

  8. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania

    Irinel Popescu MD, Razvan Grigorie MD, PhD & Sorin Alexandrescu MD

  9. Department of Surgery, University of Ottawa, Ottawa, ON, Canada

    Guillaume Martel MD & Aklile Workneh MD

  10. Department of Surgery, The University of Sydney, School of Medicine, Sydney, NSW, Australia

    Tom Hugh MD

  11. Yokohama City University School of Medicine, Yokohama, Japan

    Itaru Endo MD, PhD

Authors
  1. Diamantis I. Tsilimigras MD
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  2. Rittal Mehta MPH
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  3. Dimitrios Moris MD, PhD
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  6. Anghela Z. Paredes MD, MS
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  20. Tom Hugh MD
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  23. Timothy M. Pawlik MD, MPH, PhD, FACS, FRACS (Hon.)
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Correspondence to Timothy M. Pawlik MD, MPH, PhD, FACS, FRACS (Hon.).

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Tsilimigras, D.I., Mehta, R., Moris, D. et al. Utilizing Machine Learning for Pre- and Postoperative Assessment of Patients Undergoing Resection for BCLC-0, A and B Hepatocellular Carcinoma: Implications for Resection Beyond the BCLC Guidelines. Ann Surg Oncol 27, 866–874 (2020). https://doi.org/10.1245/s10434-019-08025-z

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