Model combining pre-transplant tumor biomarkers and tumor size shows more utility in predicting hepatocellular carcinoma recurrence and survival than the BALAD models

Nicha Wongjarupong, Gabriela M. Negron-Ocasio, Roongruedee Chaiteerakij, Benyam D. Addissie, Essa A. Mohamed, Kristin C. Mara, William S. Harmsen, J. Paul Theobald, Brian E. Peters, Joseph G. Balsanek, Melissa M. Ward, Nasra H. Giama, Sudhakar K Venkatesh, Denise Harnois, Michael R. Charlton, Hiroyuki Yamada, Alicia Algeciras-Schimnich, Melissa R. Snyder, Terry M Therneau, Lewis Rowland Roberts

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

AIM To assess the performance of BALAD, BALAD-2 and their component biomarkers in predicting outcome of hepatocellular carcinoma (HCC) patients after liver transplant. METHODS BALAD score and BALAD-2 class are derived from bilirubin, albumin, alpha-fetoprotein (AFP), Lens culinaris agglutinin-reactive AFP (AFP-L3), and des-gamma-carboxyprothrombin (DCP). Pre-transplant AFP, AFP-L3 and DCP were measured in 113 patients transplanted for HCC from 2000 to 2008. Hazard ratios (HR) for recurrence and death were calculated. Univariate and multivariate regression analyses were conducted. C-statistics were used to compare biomarker-based to predictive models. RESULTS During a median follow-up of 12.2 years, 38 patients recurred and 87 died. The HRs for recurrence in patients with elevated AFP, AFP-L3, and DCP defined by BALAD cut-off values were 2.42 (1.18-5.00), 1.86 (0.98-3.52), and 2.83 (1.42-5.61), respectively. For BALAD, the HRs for recurrence and death per unit increased score were 1.48 (1.15-1.91) and 1.59 (1.28-1.97). For BALAD-2, the HRs for recurrence and death per unit increased class were 1.45 (1.06-1.98) and 1.38 (1.09-1.76). For recurrence prediction, the combination of three biomarkers had the highest c-statistic of 0.66 vs. 0.64, 0.61, 0.53, and 0.53 for BALAD, BALAD-2, Milan, and UCSF, respectively. Similarly, for death prediction, the combination of three biomarkers had the highest c-statistic of 0.66 vs 0.65, 0.61, 0.52, and 0.50 for BALAD, BALAD-2, Milan, and UCSF. A new model combining biomarkers with tumor size at the time of transplant (S-LAD) demonstrated the highest predictive capability with c-statistics of 0.71 and 0.69 for recurrence and death. CONCLUSION BALAD and BALAD-2 are valid in transplant HCC patients, but less predictive than the three biomarkers in combination or the three biomarkers in combination with maximal tumor diameter (S-LAD).

Original languageEnglish (US)
Pages (from-to)1321-1331
Number of pages11
JournalWorld Journal of Gastroenterology
Volume24
Issue number12
DOIs
StatePublished - Mar 28 2018

Fingerprint

alpha-Fetoproteins
Tumor Biomarkers
Hepatocellular Carcinoma
Transplants
Biomarkers
Recurrence
Survival
Neoplasms
Bilirubin
Albumins
Multivariate Analysis
Regression Analysis
Liver
acarboxyprothrombin

Keywords

  • AFP-L3
  • Alpha-fetoprotein
  • BALAD
  • BALAD-2
  • Des-gamma-carboxyprothrombin
  • Hepatocellular carcinoma
  • Liver transplant
  • Outcome
  • Recurrence

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Model combining pre-transplant tumor biomarkers and tumor size shows more utility in predicting hepatocellular carcinoma recurrence and survival than the BALAD models. / Wongjarupong, Nicha; Negron-Ocasio, Gabriela M.; Chaiteerakij, Roongruedee; Addissie, Benyam D.; Mohamed, Essa A.; Mara, Kristin C.; Harmsen, William S.; Theobald, J. Paul; Peters, Brian E.; Balsanek, Joseph G.; Ward, Melissa M.; Giama, Nasra H.; Venkatesh, Sudhakar K; Harnois, Denise; Charlton, Michael R.; Yamada, Hiroyuki; Algeciras-Schimnich, Alicia; Snyder, Melissa R.; Therneau, Terry M; Roberts, Lewis Rowland.

In: World Journal of Gastroenterology, Vol. 24, No. 12, 28.03.2018, p. 1321-1331.

Research output: Contribution to journalReview article

Wongjarupong, N, Negron-Ocasio, GM, Chaiteerakij, R, Addissie, BD, Mohamed, EA, Mara, KC, Harmsen, WS, Theobald, JP, Peters, BE, Balsanek, JG, Ward, MM, Giama, NH, Venkatesh, SK, Harnois, D, Charlton, MR, Yamada, H, Algeciras-Schimnich, A, Snyder, MR, Therneau, TM & Roberts, LR 2018, 'Model combining pre-transplant tumor biomarkers and tumor size shows more utility in predicting hepatocellular carcinoma recurrence and survival than the BALAD models', World Journal of Gastroenterology, vol. 24, no. 12, pp. 1321-1331. https://doi.org/10.3748/wjg.v24.i12.1321
Wongjarupong, Nicha ; Negron-Ocasio, Gabriela M. ; Chaiteerakij, Roongruedee ; Addissie, Benyam D. ; Mohamed, Essa A. ; Mara, Kristin C. ; Harmsen, William S. ; Theobald, J. Paul ; Peters, Brian E. ; Balsanek, Joseph G. ; Ward, Melissa M. ; Giama, Nasra H. ; Venkatesh, Sudhakar K ; Harnois, Denise ; Charlton, Michael R. ; Yamada, Hiroyuki ; Algeciras-Schimnich, Alicia ; Snyder, Melissa R. ; Therneau, Terry M ; Roberts, Lewis Rowland. / Model combining pre-transplant tumor biomarkers and tumor size shows more utility in predicting hepatocellular carcinoma recurrence and survival than the BALAD models. In: World Journal of Gastroenterology. 2018 ; Vol. 24, No. 12. pp. 1321-1331.
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title = "Model combining pre-transplant tumor biomarkers and tumor size shows more utility in predicting hepatocellular carcinoma recurrence and survival than the BALAD models",
abstract = "AIM To assess the performance of BALAD, BALAD-2 and their component biomarkers in predicting outcome of hepatocellular carcinoma (HCC) patients after liver transplant. METHODS BALAD score and BALAD-2 class are derived from bilirubin, albumin, alpha-fetoprotein (AFP), Lens culinaris agglutinin-reactive AFP (AFP-L3), and des-gamma-carboxyprothrombin (DCP). Pre-transplant AFP, AFP-L3 and DCP were measured in 113 patients transplanted for HCC from 2000 to 2008. Hazard ratios (HR) for recurrence and death were calculated. Univariate and multivariate regression analyses were conducted. C-statistics were used to compare biomarker-based to predictive models. RESULTS During a median follow-up of 12.2 years, 38 patients recurred and 87 died. The HRs for recurrence in patients with elevated AFP, AFP-L3, and DCP defined by BALAD cut-off values were 2.42 (1.18-5.00), 1.86 (0.98-3.52), and 2.83 (1.42-5.61), respectively. For BALAD, the HRs for recurrence and death per unit increased score were 1.48 (1.15-1.91) and 1.59 (1.28-1.97). For BALAD-2, the HRs for recurrence and death per unit increased class were 1.45 (1.06-1.98) and 1.38 (1.09-1.76). For recurrence prediction, the combination of three biomarkers had the highest c-statistic of 0.66 vs. 0.64, 0.61, 0.53, and 0.53 for BALAD, BALAD-2, Milan, and UCSF, respectively. Similarly, for death prediction, the combination of three biomarkers had the highest c-statistic of 0.66 vs 0.65, 0.61, 0.52, and 0.50 for BALAD, BALAD-2, Milan, and UCSF. A new model combining biomarkers with tumor size at the time of transplant (S-LAD) demonstrated the highest predictive capability with c-statistics of 0.71 and 0.69 for recurrence and death. CONCLUSION BALAD and BALAD-2 are valid in transplant HCC patients, but less predictive than the three biomarkers in combination or the three biomarkers in combination with maximal tumor diameter (S-LAD).",
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TY - JOUR

T1 - Model combining pre-transplant tumor biomarkers and tumor size shows more utility in predicting hepatocellular carcinoma recurrence and survival than the BALAD models

AU - Wongjarupong, Nicha

AU - Negron-Ocasio, Gabriela M.

AU - Chaiteerakij, Roongruedee

AU - Addissie, Benyam D.

AU - Mohamed, Essa A.

AU - Mara, Kristin C.

AU - Harmsen, William S.

AU - Theobald, J. Paul

AU - Peters, Brian E.

AU - Balsanek, Joseph G.

AU - Ward, Melissa M.

AU - Giama, Nasra H.

AU - Venkatesh, Sudhakar K

AU - Harnois, Denise

AU - Charlton, Michael R.

AU - Yamada, Hiroyuki

AU - Algeciras-Schimnich, Alicia

AU - Snyder, Melissa R.

AU - Therneau, Terry M

AU - Roberts, Lewis Rowland

PY - 2018/3/28

Y1 - 2018/3/28

N2 - AIM To assess the performance of BALAD, BALAD-2 and their component biomarkers in predicting outcome of hepatocellular carcinoma (HCC) patients after liver transplant. METHODS BALAD score and BALAD-2 class are derived from bilirubin, albumin, alpha-fetoprotein (AFP), Lens culinaris agglutinin-reactive AFP (AFP-L3), and des-gamma-carboxyprothrombin (DCP). Pre-transplant AFP, AFP-L3 and DCP were measured in 113 patients transplanted for HCC from 2000 to 2008. Hazard ratios (HR) for recurrence and death were calculated. Univariate and multivariate regression analyses were conducted. C-statistics were used to compare biomarker-based to predictive models. RESULTS During a median follow-up of 12.2 years, 38 patients recurred and 87 died. The HRs for recurrence in patients with elevated AFP, AFP-L3, and DCP defined by BALAD cut-off values were 2.42 (1.18-5.00), 1.86 (0.98-3.52), and 2.83 (1.42-5.61), respectively. For BALAD, the HRs for recurrence and death per unit increased score were 1.48 (1.15-1.91) and 1.59 (1.28-1.97). For BALAD-2, the HRs for recurrence and death per unit increased class were 1.45 (1.06-1.98) and 1.38 (1.09-1.76). For recurrence prediction, the combination of three biomarkers had the highest c-statistic of 0.66 vs. 0.64, 0.61, 0.53, and 0.53 for BALAD, BALAD-2, Milan, and UCSF, respectively. Similarly, for death prediction, the combination of three biomarkers had the highest c-statistic of 0.66 vs 0.65, 0.61, 0.52, and 0.50 for BALAD, BALAD-2, Milan, and UCSF. A new model combining biomarkers with tumor size at the time of transplant (S-LAD) demonstrated the highest predictive capability with c-statistics of 0.71 and 0.69 for recurrence and death. CONCLUSION BALAD and BALAD-2 are valid in transplant HCC patients, but less predictive than the three biomarkers in combination or the three biomarkers in combination with maximal tumor diameter (S-LAD).

AB - AIM To assess the performance of BALAD, BALAD-2 and their component biomarkers in predicting outcome of hepatocellular carcinoma (HCC) patients after liver transplant. METHODS BALAD score and BALAD-2 class are derived from bilirubin, albumin, alpha-fetoprotein (AFP), Lens culinaris agglutinin-reactive AFP (AFP-L3), and des-gamma-carboxyprothrombin (DCP). Pre-transplant AFP, AFP-L3 and DCP were measured in 113 patients transplanted for HCC from 2000 to 2008. Hazard ratios (HR) for recurrence and death were calculated. Univariate and multivariate regression analyses were conducted. C-statistics were used to compare biomarker-based to predictive models. RESULTS During a median follow-up of 12.2 years, 38 patients recurred and 87 died. The HRs for recurrence in patients with elevated AFP, AFP-L3, and DCP defined by BALAD cut-off values were 2.42 (1.18-5.00), 1.86 (0.98-3.52), and 2.83 (1.42-5.61), respectively. For BALAD, the HRs for recurrence and death per unit increased score were 1.48 (1.15-1.91) and 1.59 (1.28-1.97). For BALAD-2, the HRs for recurrence and death per unit increased class were 1.45 (1.06-1.98) and 1.38 (1.09-1.76). For recurrence prediction, the combination of three biomarkers had the highest c-statistic of 0.66 vs. 0.64, 0.61, 0.53, and 0.53 for BALAD, BALAD-2, Milan, and UCSF, respectively. Similarly, for death prediction, the combination of three biomarkers had the highest c-statistic of 0.66 vs 0.65, 0.61, 0.52, and 0.50 for BALAD, BALAD-2, Milan, and UCSF. A new model combining biomarkers with tumor size at the time of transplant (S-LAD) demonstrated the highest predictive capability with c-statistics of 0.71 and 0.69 for recurrence and death. CONCLUSION BALAD and BALAD-2 are valid in transplant HCC patients, but less predictive than the three biomarkers in combination or the three biomarkers in combination with maximal tumor diameter (S-LAD).

KW - AFP-L3

KW - Alpha-fetoprotein

KW - BALAD

KW - BALAD-2

KW - Des-gamma-carboxyprothrombin

KW - Hepatocellular carcinoma

KW - Liver transplant

KW - Outcome

KW - Recurrence

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UR - http://www.scopus.com/inward/citedby.url?scp=85045061487&partnerID=8YFLogxK

U2 - 10.3748/wjg.v24.i12.1321

DO - 10.3748/wjg.v24.i12.1321

M3 - Review article

C2 - 29599607

AN - SCOPUS:85045061487

VL - 24

SP - 1321

EP - 1331

JO - World Journal of Gastroenterology

JF - World Journal of Gastroenterology

SN - 1007-9327

IS - 12

ER -