A New Prognostic Model for Radiation-Based Hepatocellular Carcinoma Treatment

Abstract

Background: There are no clinical staging models based on radiotherapy for HCC. Existing models of hepatocellular carcinoma (HCC) staging may not predict the prognosis of radiotherapy perfectly. Therefore, in this study, we created a new staging model for radiotherapy-based treatment for the prognostic classification of HCC. Methods: This multicenter cohort study included 1191 patients with HCC. The training cohort included 658 patients, who underwent stereotactic body radiotherapy, and the external validation cohort included 533 patients, who underwent intensity-modulated radiotherapy. The new staging model, and existing Barcelona Clinic Liver Cancer (BCLC), TNM, and China Liver Cancer (CNLC) staging systems, were used for prognostic analyses. Patients with HCC treated with radiotherapy were separated into different stages and substages. Long-term overall survival outcomes and time-dependent receiver operating characteristic (ROC) curves were analyzed. Findings: In the training cohort, the median follow-up time was 60·0 months (range, 6–100 months). The new staging model could separate patients into different stages with four notably different curves, and substage s with seven notably different curves. The BCLC, TNM, and CNLC staging systems could not differentiate among all the stages. In the external validation cohort, the median follow-up time was 58·0 months (range, 6–120 months). The new staging system showed discriminatory ability similar to the training cohort and a better area under the curve of time-dependent ROC compared to BCLC, TNM, and CNLC staging in the entire cohort. Interpretation: The modified staging model showed good discriminatory ability to separate patients into different stages and substages after radiotherapy and may supplement other HCC staging systems. Funding Information: National Natural Science Foundation of China (81903257); China International Medical Foundation-Tumor Precise Radiotherapy Spark Program (2019-N-11-01); Guangxi Natural Science Foundation (2020GXNSFAA297171); Guangxi BaGui Scholars’ Special Fund; Guangxi Medical University Training Program for Distinguished Young Scholars; High-level innovation team and outstanding scholar program in Guangxi Colleges and Universities. Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki as reflected in a priori approval by the Ethics Committees of Guangxi Medical University Cancer Hospital and the respective institutions (LW2021008). Written informed consent was obtained from each patient included in the study.