Abstract

Currently there is no consensus as to which staging system is best in predicting the survival of patients with hepatocellular carcinoma (HCC). The aims of this study were to identify independent predictors of survival and to compare 7 available prognostic staging systems in patients with HCC. A total of 239 consecutive patients with cirrhosis and HCC seen between January 1, 2000, and December 31, 2003, were included. Demographic, laboratory, and tumor characteristics and performance status were determined at diagnosis and before therapy. Predictors of survival were identified using the Kaplan-Meir test and the Cox model. Sixty-two percent of patients had hepatitis C, 56% had more than 1 tumor nodule, 24% had portal vein thrombosis, and 29% did not receive any cancer treatment. At the time of censorship, 153 (63%) patients had died. The 1- and 3-year survival of the entire cohort was 58% and 29%, respectively. The independent predictors of survival were performance status (P < .0001), MELD score greater than 10 (P = .001), portal vein thrombosis (P = .0001), and tumor diameter greater than 4 cm (P = .001). Treatment of HCC was related to overall survival. The Barcelona Clinic Liver Cancer (BCLC) staging system had the best independent predictive power for survival when compared with the other 6 prognostic systems. In conclusion, performance status, tumor extent, liver function, and treatment were independent predictors of survival mostly in patients with cirrhosis and HCC. The BCLC staging system includes aspects of all of these elements and provided the best prognostic stratification for our cohort of patients with HCC.

Highlights

  • Hepatocellular carcinoma (HCC) is the fifth most common tumor worldwide

  • Consecutive patients with hepatocellular carcinoma (HCC) seen in the Liver Clinics at the University of Michigan Medical Center were enrolled into a database that was approved by the Institutional Review Board

  • A treatment algorithm was followed (Fig. 1) in which all patients were first assessed for resection; if deemed ineligible, liver transplantation was considered if the patient met United Network of Organ Sharing (UNOS) criteria

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Summary

Introduction

Hepatocellular carcinoma (HCC) is the fifth most common tumor worldwide. In the United States, the incidence of HCC has been rising,[1] and it is the tumor with the largest increase in incidence over the last 12 years.[2]. Four key factors that may affect the prognosis of patients with HCC have been identified[7]: (1) tumor stage at diagnosis; (2) overall health of the patient; (3) hepatic synthetic function; and (4) efficacy of treatment. The aims of this study were to identify independent predictors of survival at the time of HCC diagnosis in a single center and to compare the ability of 7 existing HCC staging systems in predicting survival in a cohort of patients with HCC

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