Predicting when liver cancer will recur

SLICER is a new tool for clinicians to accurately assess the risk that liver cancer will recur after a patient undergoes surgery

For people diagnosed with liver cancer, surgery is often their best treatment option. But even after an operation to remove the tumour, the disease frequently recurs.

To accurately predict the likelihood of a recurrence and identify the patients who might benefit from adjuvant or additional treatment, a liver transplant or closer follow-up, a new tool known as the Singapore Liver Cancer Recurrence Score (SLICER) has been developed by doctors from the Singapore General Hospital (SGH) and National Cancer Centre Singapore (NCCS).

Recurrence is difficult and costly to predict because of the many types of liver cancer. But knowing if and when the disease will return helps doctors determine a patient’s next course of treatment.

“Who do we choose for close monitoring after surgery? Should we subject everybody to frequent follow-up, and therefore spend a lot of resources? Or do we use a longer interval and potentially miss an early tumour? These are the questions that clinicians face,” said Associate Professor Cheow Peng Chung, Senior Consultant, Department of Hepato-pancreatobiliary and Transplant Surgery, SGH.

Most of the tools available for predicting a recurrence of liver cancer were developed based on patients with advanced cancer, so are less relevant for this group of patients whose cancer was diagnosed early enough for a surgical resection (removal of part of the organ).

Moreover, the tests typically classify patients into groups with varying outcomes, instead of predicting individualised outcomes.

SLICER was developed by analysing 405 patients who underwent first-line liver resection surgery between 1992 and 2007 at SG H. In a study published in the leading Public Library of Science (PLOS)