Abstract
Background and aimThere are several prognostic systems that address different aspects of the patient and the tumour and can guide the management of patients with hepatocellular carcinoma (HCC). This study aimed to evaluate and compare the eight staging systems for a group of patients in a public service in Brazil.MethodsPatients with HCC were retrospectively analysed between 2000 and 2012. The prognostic systems Okuda, The Cancer of the Liver Italian Program (CLIP), the Chinese University Prognostic Index (CUPI), Groupe d'Etude et de Traitément du Carcinome Hepatocellulaire (GRETCH), the modified TNM-based Japan Integrated Score (JIS) combined with alpha-fetoprotein and Child-Turcotte-Pugh (CTP), the TNM system, and the Barcelona Clinic Liver Cancer Classification (BCLC) were applied to these patients and compared through model fit measurements, likelihood scores, and the Akaike Information Criterion (AIC).ResultsA total of 247 patients were studied. The average survival time was 60 months. The TNM, Okuda, CLIP, GRETCH, modified JIS, and BCLC systems were well correlated with one another and individually important to the prediction of survival among the patients studied. However, in the statistical analysis, the CUPI delivered the best predictive performance (AIC = 566; log-likelihood = -281,240).ConclusionAlthough the CUPI system was demonstrated to be the most appropriate HCC staging system for the studied population, the choice of an ideal system is a controversial subject, and future studies with larger numbers of patients are necessary for the validation of the CUPI system as the method of choice for other populations.
Highlights
Hepatocellular carcinoma (HCC) is responsible for approximately 250,000 to 1 million deaths per year worldwide [1,2,3]
Comparative analysis of prognostic systems in hepatocellular carcinoma future studies with larger numbers of patients are necessary for the validation of the Chinese University Prognostic Index (CUPI) system as the method of choice for other populations
The Barcelona Clinic Liver Cancer Classification (BCLC) system [16] addresses the aspects of a tumour, CTP, performance status, cancer symptoms and treatments options (Table 1)
Summary
Hepatocellular carcinoma (HCC) is responsible for approximately 250,000 to 1 million deaths per year worldwide [1,2,3]. The Chinese University Prognostic Index (CUPI) [11] analyses tumour-node-metastasis (TNM) stage and clinical and laboratory data including bilirubin, alkaline phosphatase and AFP level (>500ng/mL). The Barcelona Clinic Liver Cancer Classification (BCLC) system [16] addresses the aspects of a tumour (size, extension and presence of portal vein thrombosis/extrahepatic metastasis), CTP, performance status, cancer symptoms and treatments options (Table 1). Among these systems, the CUPI was validated in a cohort consisting mostly of hepatitis virus B-infected patients, and CLIP and JIS scores are primarily designed for hepatitis C patients.
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