Redefining Tumor Burden in Patients with Intermediate-Stage Hepatocellular Carcinoma: The Seven-Eleven Criteria

Ya-Wen Hung; I-Cheng Lee; Chen-Ta Chi; Rheun-Chuan Lee; Chien-An Liu; Nai-Chi Chiu; Hsuen-En Hwang; Yee Chao; Ming-Chih Hou; Yi-Hsiang Huang

doi:10.1159/000517393

Redefining Tumor Burden in Patients with Intermediate-Stage Hepatocellular Carcinoma: The Seven-Eleven Criteria

Liver Cancer. 2021 Jul 22;10(6):629-640. doi: 10.1159/000517393. eCollection 2021 Nov.

Authors

Ya-Wen Hung¹, I-Cheng Lee^{1

2}, Chen-Ta Chi^{1

2

3}, Rheun-Chuan Lee⁴, Chien-An Liu⁴, Nai-Chi Chiu⁴, Hsuen-En Hwang⁴, Yee Chao⁵, Ming-Chih Hou^{1

2}, Yi-Hsiang Huang^{1

2

3}

Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
² Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan.
³ Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁴ Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.
⁵ Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan.

Abstract

Background and aims: For patients with intermediate-stage hepatocellular carcinoma (HCC), the definition of high tumor burden remains controversial. This study aimed to compare the prognostic value of different criteria of tumor burden in patients with intermediate-stage HCC undergoing transarterial chemoembolization (TACE).

Methods: From 2007 to 2019, 632 treatment-naive patients with intermediate-stage HCC undergoing TACE were retrospectively enrolled. We compared different criteria of tumor burden in discriminating radiologic response and survival, including up-to-7, up-to-11, 5-7, 7 lesions criteria, and newly proposed 7-11 criteria.

Results: The proportions of patients classified as high tumor burden were varied by different criteria. Among the 5 criteria, 7-11 criteria have the best performance to discriminate complete response (CR) and overall survival (OS) after TACE. In patients with low, intermediate, and high tumor burden classified by 7-11 criteria, the CR rate was 21, 12, and 2.5%, respectively (p < 0.001), and the median OS was 33.1, 22.3, and 11.9 months, respectively (p < 0.001). By multivariate analysis, 7-11 criteria were significantly associated with CR (intermediate vs. high burden, odds ratio = 4.617, p = 0.002; low vs. high burden, odds ratio = 8.675, p < 0.001) and OS (intermediate vs. high burden, hazard ratio = 0.650, p < 0.001; low vs. high burden, hazard ratio = 0.520, p < 0.001). Seven to 11 criteria also had the lowest corrected Akaike information criteria, highest homogeneity value, and highest area under the receiver operating characteristic curve in predicting 1-, 2-, and 3-year mortality among all criteria.

Conclusion: Conventional definitions of tumor burden were not optimal for patients with intermediate HCC. The new 7-11 criteria had the best discriminative power in predicting radiologic response and survival in patients with intermediate-stage HCC undergoing TACE.

Keywords: Hepatocellular carcinoma; Transarterial chemoembolization; Tumor burden.