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Original Article
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Comparison of 7 staging systems for patients with hepatocellular carcinoma undergoing transarterial chemoembolization
Article first published online: 15 NOV 2007
DOI: 10.1002/cncr.23185
Copyright © 2007 American Cancer Society
Additional Information
How to Cite
Cho, Y. K., Chung, J. W., Kim, J. K., Ahn, Y. S., Kim, M. Y., Park, Y. O., Kim, W. T. and Byun, J. H. (2008), Comparison of 7 staging systems for patients with hepatocellular carcinoma undergoing transarterial chemoembolization. Cancer, 112: 352–361. doi: 10.1002/cncr.23185
Publication History
- Issue published online: 4 JAN 2008
- Article first published online: 15 NOV 2007
- Manuscript Accepted: 21 AUG 2007
- Manuscript Revised: 30 JUL 2007
- Manuscript Received: 6 APR 2007
- Abstract
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Keywords:
- hepatocellular carcinoma;
- staging system;
- prognostic index;
- survival
Abstract
BACKGROUND.
Many liver staging systems have been proposed for patients with hepatocellular carcinoma after locoregional therapy; however, controversies persist regarding which system is the best. In this study, the authors compared the performance of 7 staging systems in a cohort of patients with hepatocellular carcinoma who underwent transarterial chemoembolization.
METHODS.
In total, 131 patients with hepatocellular carcinoma who underwent transarterial chemoembolization between August 1998 and February 2005 were included in the study. Demographic, laboratory, and tumor characteristics were determined at diagnosis and before therapy. At the time of censorship, 109 patients had died (83.2%). Predictors of survival were identified by using the Cox proportional hazards model. The likelihood-ratio chi-square statistic and the Akaike Information Criterion were calculated for 7 prognostic systems to evaluate their discriminatory ability. Comparisons of the survival rate between each stage were performed to evaluate the monotonicity of the gradients using Kaplan-Meier estimation and the log-rank test.
RESULTS.
The 5-year survival rate for the entire cohort was 13.6%. The independent predictors of survival were serum albumin level (≤3.4 g/dL), the presence of ascites, serum α-fetoprotein level (>60 ng/mL), and portal or hepatic vein tumor thrombosis (P = .001, P = .001, P = .004, and P = .000, respectively). The Cancer of the Liver Italian Program classification system was superior to the other 6 prognostic systems regarding discriminatory ability and the monotonicity of the gradients.
CONCLUSIONS.
In this comparison of many staging systems, the Cancer of Liver Italian Program system provided the best prognostic stratification for a cohort the patients with hepatocellular carcinoma who underwent transarterial chemoembolization. Cancer 2008. © 2007 American Cancer Society.