Abstract
PurposeThis study is to evaluate the Hangzhou criteria (HC) for patients with HCC undergoing surgical resection and to identify whether this staging system is superior to other staging systems in predicting the survival of resectable HCC.Method774 HCC patients underwent surgical resection between 2007 and 2009 in West China Hospital were enrolled retrospectively. Predictors of survival were identified using the Kaplan–Meier method and the Cox model. The disease state was staged by the HC, as well as by the TNM and BCLC staging systems. Prognostic powers were quantified using a linear trend χ2 test, c-index, and the likelihood ratio (LHR) χ2 test and correlated using Cox's regression model adjusted using the Akaike information criterion (AIC).ResultsSerum AFP level (P = 0.02), tumor size (P<0.001), tumor number (P<0.001), portal vein invasion (P<0.001), hepatic vein invasion (P<0.001), tumor differentiation (P<0.001), and distant organ (P = 0.016) and lymph node metastasis (P<0.001) were identified as independent risk factors of survival after resection by multivariate analysis. The comparison of the different staging system results showed that BCLC had the best homogeneity (likelihood ratio χ2 test 151.119, P<0.001), the TNM system had the best monotonicity of gradients (linear trend χ2 test 137.523, P<0.001), and discriminatory ability was the highest for the BCLC (the AUCs for 1-year mortality were 0.759) and TNM staging systems (the AUCs for 3-, and 5-year mortality were 0.738 and 0.731, respectively). However, based on the c-index and AIC, the HC was the most informative staging system in predicting survival (c-index 0.6866, AIC 5924.4729).ConclusionsThe HC can provide important prognostic information after surgery. The HC were shown to be a promising survival predictor in a Chinese cohort of patients with resectable HCC.
Highlights
Hepatocellular carcinoma (HCC) is the fifth most common carcinoma in the world; over half a million cases occur per year, and a gradual increase in its annual incidence has been reported in recent years [1,2]
Between July 1, 2007 and December 31, 2009, 1857 patients with HCC were seen by medical oncologists at the Department of Liver Surgery, West China Hospital, Sichuan University; of these, 1083 patients were excluded from the study pool because of did not received the hepatectomy or important data missed
The remaining 774 patients were staged using each of the three different staging systems discussed in the methods section
Summary
Hepatocellular carcinoma (HCC) is the fifth most common carcinoma in the world; over half a million cases occur per year, and a gradual increase in its annual incidence has been reported in recent years [1,2]. HCC’s worldwide distribution is heterogeneous and closely related to different risk factors. It is difficult to establish a standard staging system that feasibly predicts survival in all HCC patients [6,7]; HCC’s disease pattern is heterogeneous in its molecular and clinicopathological features, with diverse etiologies [8], and there are various treatment modalities among different centers. Among the several staging systems, the Tumor-Node-Metastasis (TNM) system is one of the most widely accepted, and the 7th edition was published by the American Joint Committee on Cancer (AJCC) in 2009 [9]. The major modification from the 6th to the 7th edition was the separation of the T3 stage into T3a and T3b; this change indicates major vascular invasion of portal or hepatic veins as an important predictive factor for prognosis.
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