Abstract
There is significant heterogeneity in the clinicopathological characteristics of intermediate hepatocellular carcinoma (IHCC). This also translates to treatment as transarterial chemoembolization (TACE) is used as first-line therapy for patients with IHCC; however, in Asia liver resection (LR) is preferred. Prognostic tools are required to help guide clinicians in deciding treatment options. This study evaluates the prognostic impact of the Intermediate Stage Score (ISS) on overall survival (OS) in a large, multicenter cohort study of patients with IHCC treated with TACE or surgery LR. Consecutive patients from centers in Japan, Korea, Italy and the United Kingdom who underwent TACE or LR between 2001 and 2015 were enrolled. Propensity score (PS) adjustment was used to remove residual confounding and applied to LR (n = 162) and TACE (n = 449) to determine the prognostic significance of ISS. Among 611 patients, 75 % were men and 25 % women, with a mean age of 70 years. ISS is a valid prognostic tool in the BCLC-B population with a median OS ISS 1–51, 2–38.3, 3–24.3, 4–15.6, 5–16 months (p < 0.0001). ISS was analyzed within each treatment modality, and this was a valid prognostic score among those treated with TACE and LR (p < 0.001 vs. p = 0.008). In the PS-adjusted model, ISS retained its prognostic utility in TACE and LR groups (p < 0.001 vs. p = 0.007). ISS optimizes prognostic prediction in IHCC, reducing clinical heterogeneity, and is a useful tool for patients treated for TACE or LR.
Highlights
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death in patients with liver cirrhosis, with more than new 700,000 cases diagnosed yearly worldwide [1, 2]
This study evaluates the prognostic impact of the Intermediate Stage Score (ISS) on overall survival (OS) in a large, multicenter cohort study of patients with intermediate hepatocellular carcinoma (IHCC) treated with transarterial chemoembolization (TACE) or surgery liver resection (LR)
This is the first large, multi-center study to validate the prognostic ability of the ISS in patients with Barcelona Clinic Liver Cancer (BCLC)-B stage disease, independent of treatment received
Summary
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death in patients with liver cirrhosis, with more than new 700,000 cases diagnosed yearly worldwide [1, 2]. Over the past few decades, it has become clear that the natural history of HCC strongly depends on anatomical stage, underlying liver function and overall patients’ physical status: this has led to the development of several prognostic algorithms with intent to optimize treatment [3,4,5,6,7]. The Barcelona Clinic Liver Cancer (BCLC) stage includes prognostic variables such as tumor stage, performance status, and Child–Turcotte–Pugh (CTP) class [8]. Formulating appropriate treatment strategies for the individual patient is difficult within this nebulous BCLC-B staging system
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