Abstract
305 Background: Many liver staging systems that include the tumor stage and the extent of liver function have been developed. However, Prognosis assessment for hepatocellular carcinoma (HCC) remains controversial. In this study, the performances of 7 staging systems were compared in a cohort of patients with HCC who underwent non-surgical treatment. Methods: A total of 196 consecutive patients with HCC who underwent non-surgical treatment seen between January 1, 2004, and December 31, 2007, were included. Performances of TNM sixth edition, Okuda, Barcelona Clinic Liver Cancer (BCLC), Cancer of the Liver Italian Program (CLIP), Chinese University Prognostic Index (CUPI), Japan Integrated Staging (JIS), and China integrated score (CIS) have been compared and ranked using concordance index (c-index). Predictors of survival were identified using univariate and multivariate Cox model analyses. Results: The median survival time for the cohort was 7.6 months (95% CI 5.6-9.7). The independent predictors of survival were performance status (P <.001), serum sodium (P <.001), alkaline phosphatase (P <.001), tumor diameter greater than 5 cm (P =.001), portal vein invasion (P <.001), lymph node metastasis (P =.025), distant metastasis (P =.004). CUPI staging system had the best independent predictive power for survival when compared with the other six prognostic systems. Performance status and serum sodium improved the discriminatory ability of CUPI. Conclusions: In our selected patient population whose main etiology is hepatitis B, CUPI was the most suitable staging systems in predicting survival in patients with unresectable HCC. BCLC was the second top-ranking staging system. CLIP, JIS, CIS, and TNM sixth edition were not helpful in predicting survival outcome, and their use is not supported by our data. Clinical trial information: 1103-10.
Highlights
Clinical staging for cancers provides a guidance to predict survival outcome and to decide optimal treatment strategies
This study focuses on patients with unresectable hepatocellular carcinoma (HCC) in an intermediate-advanced setting mainly associated with hepatitis B virus etiology
Patient characteristics and overall survival A total of 196 patients with unresectable HCC were included in the study
Summary
Clinical staging for cancers provides a guidance to predict survival outcome and to decide optimal treatment strategies. Unlike other solid tumors, the prognosis and treatment options for patients with hepatocellular carcinoma (HCC) depend on the tumor stage and on the extent of liver dysfunction. On the basis of identification of relevant prognostic factors for both the liver cancer and liver function, many staging systems that included both aspects had been developed. As limited numbers of HCC patients are eligible for curative therapies such as surgery or ablation in Asia at present. It lacks of a quantitative assessment of its predictive value. Many liver staging systems that include the tumor stage and the extent of liver function have been developed. The performances of 7 staging systems were compared in a cohort of patients with HCC who underwent non-surgical treatment
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