Evaluations of seven different clinical staging systems for Chinese patients with hepatocellular carcinoma undergoing curative resection

Abstract

To compare the performance of 7 prognostic staging systems in predicting the survival of surgical patients with hepatocellular carcinoma (HCC). A total of 908 surgical HCC patients were recruited from January, 1999 to December, 2010 at our hospital. They were assigned retrospectively into different stages according to the classification criteria of 7 different staging systems. That is, Tumor-Node-Metastasis classification system (TNM7th), Barcelona Clinic Liver Cancer staging system (BCLC), Tokyo score, Japan Integrated Staging score (JIS), model for the Chinese University Prognostic Index grade (CUPI), Cancer of the Liver Italian Program score (CLIP) and Okuda staging. Kaplan-Meier survival estimations were performed and P values assessed with Log-rank test. Significant survival difference was found across all groups of these staging systems(P < 0.05) except for comparison between TNM7th Stage IV versus III (P = 0.538), Tokyo score 4 versus 3 (P = 0.290) and 1 versus 0(P = 0.398), CLIP score 4 versus 3 (P = 0.073) and 3 versus 2 (P = 0.805) and Okuda stage II versus stage I (P = 0.872). For neutralizing potential bias in comparing prognostic scores with different numbers of stages, Akaike information criterion (AIC) was calculated by the results of Cox's regression. Therefore TNM7th had the lowest AIC result (AIC = 3 719.39). TNM7th staging system is a better staging model for HCC of Chinese population among seven currently applied staging systems.