A novel algorithm, the Modified Metroticket, has been developed by researchers at Duke-NUS Medical School to improve decision-making for patients with intermediate-stage liver cancer undergoing surgery. This tool provides a more accurate prediction of overall survival and recurrence-free survival, addressing a critical need in hepatocellular carcinoma (HCC) treatment planning.
The algorithm, born from a collaboration between Dr. Marjorie Hoang and Professor Pierce Chow, adapts the existing Metroticket calculator, initially designed for liver transplant prognosis, to the specific challenges of surgical resection in intermediate-stage HCC. According to Prof. Chow, the Modified Metroticket considers key factors such as "the patient's tumour burden, degree of biological aggressiveness of the tumour, liver function and age."
Addressing Unmet Needs in HCC Treatment
HCC is a significant global health concern, ranking as the seventh most common and fourth deadliest cancer worldwide. The highest incidence rates are observed in East and Southeast Asia. Early detection is challenging, with most diagnoses occurring at advanced stages. While treatment strategies are well-defined for early-stage HCC, intermediate-stage disease presents a complex landscape with varied treatment options, including surgery, radiation, and immunotherapy.
Dr. Hoang explained the limitations of current staging systems: "For early-stage HCC patients, the Milan criteria is often used to choose patients who are eligible for surgical resection. Surgery also remains a widely used therapy in intermediate-stage HCC although there has been no good model to prognosticate survival after resection among patients in this group."
Modified Metroticket: A Precision Medicine Tool
The Modified Metroticket algorithm was validated using both local and international datasets, demonstrating its ability to accurately predict overall survival and recurrence-free survival. In the Singapore cohort, the Modified Metroticket outperformed the standard staging system by the American Joint Committee on Cancer. The algorithm is available as an online calculator, empowering clinicians and patients to make more informed treatment decisions.
Clinical Impact and Future Directions
Professor Chow emphasized the potential impact of the algorithm: "This algorithm, made available in the form of an online calculator, will empower doctors and patients to potentially change clinical practice." The development of the Modified Metroticket represents a significant step forward in precision medicine for liver cancer, offering a more tailored approach to surgical treatment planning.
