Development Of A Prognostic Scoring System To Predict Benefits Of Hepatic Resection In Barcelona Clinic Liver Cancer C Stage Patients

Objective:This study aimed to identify risk factors for overall survival in advanced HCC patients and establish a scoring system to select patients who would benefit from hepatic resection.Methods:Survival data in 403 advanced HCC patients were retrospectively analyzed in Guangxi Medical Univisity Affiliated Tumor Hospitl.The Chi-square test compared the differences between the age groups.The receiver operatin characteristic curve(ROC)calculates the optimal cut off value of the variable.Survival curves were analyzed using the Kaplan-Meier method and Log-rank test.Cox stepwise regression analysis was used to identify independent preoperative risk factors affecting overall survival.A prognostic scoring system based on independent risk factors and their relative coefficients was established to screen patients with greater hepatic resection benefits,and the identification ability of the model was compared based on the area under curve(AUC)of ALBI/Child-Pugh/AFP.Results:A total of 403 patients with advanced hepatocellular carcinoma(HCC)were enrolled in this study,including 360 males and 43 females.By the end of the last follow-up,314 patients died and 89 survived.The median survival in all patients was 13±2.31 months.Rate of overall survival was 51.1%at 1 year,26.3%at 3 years and 18.7%at 5 years.Multivariable Cox regression analyses found five risk factors:younger age(<50 years),lower body mass index(<18.5kg/m~2),higher alkaline phosphatase(≥80U/L),more tumor number(>1),and incomplete tumor capsule.A prognostic scoring system was established based on these five variables.The final model was prognostic score=age(≥50 years=0,<50 years=1)+BMI(≥18.5=0,<18.5=2)+ALP(<80U/L=0,≥80 U/L=2)+tumor number(1=0,>1=2)+tumor capsule(complete=0,incomplete=2).The AUC of the scoring system was 0.739(95%CI:0.685-0.793),and AFP(AUC=0.522,95%CI:0.453-0.590),Child-Pugh(AUC=0.549,95%CI:0.479-0.619)and ALBI(AUC=0.542,95%CI:0.473-0.610).Patients were classified as low-or high-risk group for hepatic resection depending on whether their score was<4 or≥4,respectively.High-risk patients had a median survival of 10 months,compared to 28 months in low-risk patients.Low-risk patients also had better survival rates at 1 year(66.2 vs.42.4%),3 years(42.5 vs.17.0%),and 5 years(34.4 vs.10.6%).Conclusion:A prognostic scoring system for hepatic resection in advanced HCC patients has been developed based entirely on preoperative variables.Patients classified as low risk using this system may experience better prognosis after surgery.