Predicting prognosis of patients with advanced hepatocellular carcinoma treated with antiangiogenic therapy using the CUPI and CLIP staging systems.

Abstract

e14669 Background: Antiangiogenic therapy, especially sorafenib, has become the most important treatment for advanced hepatocellular carcinoma (HCC). Staging systems that correlate best with the prognosis of this group of patients are unclear. Methods: Advanced HCC patients who had been enrolled in three prospective phase II trials of first-line anti-angiogenic therapies were analyzed. Clinicopathologic characteristics, as well as corresponding staging scores according to AJCC, BCLC, Okuda, CLIP, JIS, CUPI, Tokyo, and GETCH staging systems, were analyzed for their correlation with overall survival (OS). Results: A total of 122 patients were included; 110 (90%) were male and 91 (75%) had chronic hepatitis B virus infection. All patients were of Child-Pugh class A liver reserve. The median OS was 6.0 months (95% C.I., 4.4-7.6). In multivariate analysis of clinicopathologic characteristics for prognostic prediction, male, liver involvement over 50% or infiltrative disease, hepatitis B/C virus co-infection, ECOG 1, high AFP and high ALP were independent predictors for poorer OS. By log rank test, CLIP (p < 0.001), CUPI (p < 0.001), Okuda (p < 0.001), Tokyo (p = 0.001), and GETCH (p = 0.005) staging systems were capable of differentiating OS. GETCH, CUPI, and CLIP had the highest concordance indexes (C-indexes) (0.80, 0.78 and 0.74, respectively). When all the staging systems were examined together for prediction of OS by Cox’s proportional hazards model, CUPI and CLIP stood out in the final model as best staging systems for the prediction of OS. Conclusions: Among current staging systems of HCC, CUPI and CLIP have the best prognosis-prediction power in this patient group. This study was supported by the grants of DOH98-TD-B-111-001 and DOH99-TD-B-111-001.