A Novel Prognostic Score based on Serum Alpha-Fetoprotein, Number of Nodules, and MYC Gene Status Predicts Prognosis of Patients after Liver Resection for Hepatocellular Carcinoma

Recurrence after liver surgery for hepatocellular carcinoma (HCC) remains the major dismal event affecting patient’s overall survival (OS). Several studies on gene signature showed an association between MYC deregulation and poor prognosis. We aimed to analyze prognostic factors, including MYC status, for disease free survival (DFS) and OS, as well as to develop a new prognostic model for HCC able to predict the patient’s prognosis. Methods: Sixty-three patients who underwent liver resection for HCC from January 2006 to December 2009 in a single division of the Department of Surgery at the University of Verona were included into this study. Predictors of DFS and OS were identified using univariate and multivariate survival analysis. The prognostic ability of our model was compared using Harrell’s c-index to current clinical staging systems (AJCC/TNM 7th ed., BCLC and CLIP). Results: Predictors of DFS, in both univariate and multivariable analysis were number of HCC, serum AFP, and MYC status; these variables were included in a nomogram to predict DFS. Patients were classified into two groups (high- and low-risk group) according to their predicted 12-month risk of recurrence. Patients in low-risk group showed a 36-month DFS of 43% compared to 0% for high-risk group. Furthermore, patients in low-risk group presented a 36-month OS of 70% compared to 15% for high-risk group. Our model was included in AJCC/TNM 7th ed., BCLC and CLIP staging systems. When reclassified with our model, CLIP presented the highest predictive ability (c-index=73%) compared to the others staging-systems. Conclusions: We developed a prognostic model for DFS after hepatectomy for HCC, based on MYC gene status and clinical features (number of nodules and AFP serum level). Our new prognostic model could have important clinical applications in selecting those patients who might have major benefits from surgical resection.