ERS: A simple scoring system to predict early recurrence after surgical resection for hepatocellular carcinoma

Author:

Costentin Charlotte1ORCID,Audureau Etienne2,Park Young Nyun3ORCID,Langella Serena4,Vibert Eric5,Laurent Alexis6,Cauchy François7,Scatton Olivier8,Chirica Mircea9,Rhaiem Rami10,Boleslawski Emmanuel11,di Tommaso Luca1213,Ferrero Alessandro4,Yano Hirohisa14,Akiba Jun15,Donadon Matteo1316,Nebbia Martina17,Detry Olivier18,Honoré Pierre18,Di Martino Marcello19,Schwarz Lilian20,Barbier Louise21ORCID,Nault Jean‐Charles2223ORCID,Rhee Hyungjin24,Lim Chetana8,Brustia Raffaele6,Paradis Valérie25ORCID,Guettier Catherine26,Le Bail Brigitte27,Okumura Shinya28,Blanc Jean‐Frédéric29,Calderaro Julien30

Affiliation:

1. Grenoble Alpes University, Institute for Advanced Biosciences, Research Center UGA/Inserm U 1209/CNRS 5309, Gastroenterology, Hepatology and GI Oncology Department, Digidune, Grenoble Alpes University Hospital La Tronche France

2. Service de Santé Publique Assistance Publique Hôpitaux de Paris, Hôpital Henri Mondor, and Université Paris‐Est, A‐TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC Créteil France

3. Department of Pathology, Graduate School of Medical Science, Brain Korea 21 Project Yonsei University College of Medicine Seoul Republic of Korea

4. Department of General and Oncological Surgery Ospedale Mauriziano “Umberto I” Turin Italy

5. Centre hépato‐biliaire Assistance Publique Hôpitaux de Paris, Hôpital Paul Brousse Villejuif France

6. Service de Chirurgie Digestive Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Henri Mondor Créteil France

7. Service de Chirurgie Hepato‐Bilio‐Pancréatique et Transplantation Hépatique Hôpital Beaujon, AP‐HP et Université de Paris Clichy France

8. Service de Chirurgie Digestive Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié Salpétrière Paris France

9. Service de Chirurgie Digestive CHU Grenoble‐Alpes Grenoble France

10. Service de Chirurgie Digestive CHU de Reims Reims France

11. Univ. Lille, INSERM U1189, CHU Lille, Service de Chirurgie Digestive et Transplantations Lille France

12. Unit of Pathology IRCCS Humanitas Research Hospital Rozzano, Milan Italy

13. Department of Biomedical Sciences Humanitas University Pieve Emanuele, Milan Italy

14. Department of Pathology Kurume University School of Medicine Kurume Japan

15. Department of Diagnostic Pathology Kurume University Hospital Kurume Japan

16. Department of Hepatobiliary and General Surgery Humanitas Clinical and Research Center – IRCCS Rozzano Italy

17. Department of Surgery, Colon and Rectal Surgery Unit IRCCS Humanitas Research Hospital Rozzano, Milan Italy

18. Department of Abdominal Surgery and Transplantation Centre Hospitalier Universitaire de Liege, University of Liege Liege Belgium

19. Department of Surgery, HPB Unit University Hospital La Princesa Madrid Spain

20. Service de Chirurgie Digestive CHU de Rouen Rouen France

21. Service de Chirurgie Digestive CHU de Tours Tours France

22. Liver Unit Hôpital Avicenne, Hôpitaux Universitaires Paris‐Seine‐Saint‐Denis, Assistance‐Publique Hôpitaux de Paris, Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d’Universités et Etablissements Sorbonne Paris Cité Bobigny France

23. Centre de Recherche des Cordeliers Sorbonne Université, Inserm, Université de Paris, team « Functional Genomics of Solid Tumors », Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology Paris France

24. Department of Radiology Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine Seoul Republic of Korea

25. Service d’Anatomie et de Cytologie Pathologique Assistance Publique Hôpitaux de Paris, Hôpital Beaujon, Université de Paris Clichy France

26. Service d’Anatomie et de Cytologie Pathologique Assistance Publique Hôpitaux de Paris, Hôpital Bicêtre Le Kremlin‐Bicêtre France

27. Service de Pathologie Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux Bordeaux France

28. Division of Hepato‐Biliary‐Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine Kyoto University Kyoto Japan

29. Service Hépato‐Gastroentérologie et Oncologie Digestive Centre Médico‐Chirurgical Magellan, Hôpital Haut‐Lévêque, Centre Hospitalier Universitaire de Bordeaux Bordeaux France

30. Département de Pathologie Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Henri Mondor Créteil France

Abstract

AbstractBackgroundSurgical resection (SR) is a potentially curative treatment of hepatocellular carcinoma (HCC) hampered by high rates of recurrence. New drugs are tested in the adjuvant setting, but standardised risk stratification tools of HCC recurrence are lacking.ObjectivesTo develop and validate a simple scoring system to predict 2‐year recurrence after SR for HCC.Methods2359 treatment‐naïve patients who underwent SR for HCC in 17 centres in Europe and Asia between 2004 and 2017 were divided into a development (DS; n = 1558) and validation set (VS; n = 801) by random sampling of participating centres. The Early Recurrence Score (ERS) was generated using variables associated with 2‐year recurrence in the DS and validated in the VS.ResultsVariables associated with 2‐year recurrence in the DS were (with associated points) alpha‐fetoprotein (<10 ng/mL:0; 10–100: 2; >100: 3), size of largest nodule (≥40 mm: 1), multifocality (yes: 2), satellite nodules (yes: 2), vascular invasion (yes: 1) and surgical margin (positive R1: 2). The sum of points provided a score ranging from 0 to 11, allowing stratification into four levels of 2‐year recurrence risk (Wolbers' C‐indices 66.8% DS and 68.4% VS), with excellent calibration according to risk categories. Wolber's and Harrell's C‐indices apparent values were systematically higher for ERS when compared to Early Recurrence After Surgery for Liver tumour post‐operative model to predict time to early recurrence or recurrence‐free survival.ConclusionsERS is a user‐friendly staging system identifying four levels of early recurrence risk after SR and a robust tool to design personalised surveillance strategies and adjuvant therapy trials.

Publisher

Wiley

Subject

Hepatology

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